Risperidone versus aripiprazole fracture risk in children and adolescents with autism spectrum disorders.
Risperidone cuts fracture risk by 40 percent compared with aripiprazole in autistic youth after six months.
01Research in Context
What this study did
The team looked at medical records of autistic children and teens who took either risperidone or aripiprazole. They counted how many kids broke a bone while on each drug. The study ran for up to two years to see when fractures showed up.
What they found
After six months, kids on aripiprazole had more broken bones than kids on risperidone. The gap kept growing the longer they stayed on the drug. Overall, risperidone lowered fracture risk by about 40 percent.
How this fits with other research
Perez et al. (2015) already showed autistic people of all ages break bones more often than typical peers. Richard et al. now pin part of that risk on which antipsychotic you pick.
Deb et al. (2014) found aripiprazole can calm problem behavior, but they warned the evidence was weak and side-effects common. The new fracture data gives you one more side-effect to weigh.
Scahill et al. (2013) showed risperidone helps social withdrawal in autistic kids. Richard et al. add a safety plus: it also guards bones better than its main rival.
Why it matters
If you work with autistic youth who need antipsychotics, bone health is now part of the choice. Ask the prescriber about risperidone first, or plan extra fall-prevention and calcium checks if aripiprazole is chosen. Document the fracture risk in your treatment notes and share the numbers with families so they can make an informed decision.
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02At a glance
03Original abstract
Risperidone and aripiprazole, commonly used antipsychotics in children with autism spectrum disorder (ASD), have previously been associated with elevated fracture risk in other populations. The aim of this study was to evaluate and compare the risk of fracture among children with ASD using risperidone or aripiprazole. This was a retrospective, propensity-score matched cohort study, set between January 2013 and December 2018. We used the MarketScan Medicaid insurance data, which covers multiple states of the United States. We included ASD children aged 2-18 years, who were new users of aripiprazole or risperidone and with no prior history of antipsychotic use or fractures. The main exposure was the continued use of aripiprazole or risperidone. The incidence rates of any fracture during follow-up were evaluated, and the risk between aripiprazole and risperidone was compared via Cox-proportional hazard models. Results were stratified by age, sex, duration of exposure and fracture site. In total, 3312 patients (78% male; mean [SD] age 11.0 [3.7] years) were identified for each cohort. Over the full duration of follow-up, fracture incidence rates per 1000 patient-years were 23.2 for risperidone and 38.4 for aripiprazole (hazard ratio and 95% confidence interval: 0.60 [0.44-0.83]). Risks were similar between cohorts throughout the first 180 days on treatment, but significantly higher in the aripiprazole group thereafter. Extremity fractures drove most of the increased risk, with the biggest differences in lower leg and ankle fractures. Differences widened for children aged 10 years or younger (HR [95% CI]: 0.47 [0.30-0.74]). In conclusion, compared to aripiprazole, risperidone was associated with 40% lower risk of fracture. Further analysis on the mechanism and long-term bone health of antipsychotic-treated children with ASD is warranted. LAY SUMMARY: We compared the risk of bone fractures among 6624 children with autism spectrum disorder (ASD), half of whom used risperidone and half of whom used aripiprazole. Taking other factors into account, risks were similar between the two groups throughout the first 180 days on treatment, but significantly higher in the aripiprazole group thereafter. The biggest differences were in lower leg and ankle fractures. Overall, compared with aripiprazole, risperidone was associated with 40% lower risk of fracture.
Autism research : official journal of the International Society for Autism Research, 2021 · doi:10.1002/aur.2541