Stimulant Medication Use is Associated with Increased Risk of Scaphoid Fracture and Nonunion

Abstract Stimulant medications are the first-line pharmacotherapy for attention deficit hyperactivity disorder (ADHD). Evidence suggests that they may impair bone remodeling and vascularity, raising concern for scaphoid fractures, given the bone's tenuous blood supply and propensity for nonunion. Thus, this study aimed to assess scaphoid fracture and nonunion risk in adult and pediatric patients with a history of stimulant use compared with those without. A retrospective analysis was performed using the TriNetX database. Adult and pediatric patients were stratified into stimulant and nonstimulant cohorts based on an active stimulant prescription. Exclusion criteria included corticosteroid use, tobacco use, alcohol dependence, and prior history of the outcome of interest (i.e., scaphoid fracture or scaphoid nonunion). Patients were propensity score matched on age, sex, and ADHD diagnosis. The fracture analysis evaluated the 10-year risk of scaphoid fracture, whereas the nonunion analysis assessed the 1-year incidence of scaphoid nonunion following fracture, both comparing those with and without stimulant use. A total of 361,055 adults and 250,239 pediatric patients taking stimulants, as well as 748 adults and 1,023 pediatric patients prescribed stimulants at the time of scaphoid fracture, were matched one-to-one with controls. No significant differences were observed in distributions of fracture location among nonunion cohorts. Chronic stimulant use was associated with increased risk of scaphoid fracture (pediatric risk ratio RR = 1.54, 95% confidence interval CI: 1.39–1.71; adult RR = 1.62, 95% CI = 1.41–1.87) and nonunion (pediatric RR = 2.08, 95% CI = 1.13–3.82; adult RR = 1.38, 95% CI = 1.01–1.91). Stimulant use is associated with a significantly higher risk of scaphoid fracture and nonunion in both children and adults. These findings underscore the need for hand surgeons to consider stimulant use when counseling patients and adopt a more individualized approach to managing scaphoid fractures in this population. III.