A Cross-Sectional Evaluation of the Effect of Risperidone and Selective Serotonin Reuptake Inhibitors on Bone Mineral Density in Boys

Abstract

Objective-The aim of the present study was to investigate the effect of risperidone-induced hyperprolactinemia on trabecular bone mineral density (BMD) in children and adolescents.Methods-Medically healthy 7-17yo males chronically treated, in a naturalistic setting, with risperidone were recruited through child psychiatry outpatient clinics between November 2005 and June 2007. Anthropometric measurements and laboratory testing were conducted. Developmental and treatment history was obtained from the medical record. Volumetric BMD of the ultra-distal radius was measured using peripheral quantitative computerized tomography and areal BMD of the lumbar spine was estimated using dual energy X-ray absorptiometry.Results-Hyperprolactinemia was present in 49% of 83 boys (n=41) treated with risperidone for an average of 2.9 years. Serum testosterone concentration increased with pubertal status but was not affected by hyperprolactinemia. As expected, bone mineral content and BMD increased with sexual maturity. After adjusting for the stage of sexual development, height and BMI Z-scores, serum prolactin was negatively associated with trabecular volumetric BMD at the ultra-distal radius (p<0.03). Controlling for relevant covariates, we also found treatment with selective serotonin reuptake inhibitors (SSRIs) to be associated with lower trabecular BMD at the radius (p=0.03) and BMD Z-score at the lumbar spine (p<0.05). These findings became more marked when the analysis

Bone mineral density in male adolescents with autism spectrum disorders and disruptive behavior disorder with or without antipsychotic treatment

“…We could hypothesize that more severely ill patients had specific dietary restrictions and/or food selectivity and less physical exercise and this could have had a negative influence on their BMD. Another potential limitation is that the boys were allowed to use concomitant prolactin-elevating medication, such as melatonin and selective serotonin reuptake inhibitors, which could have influenced the prolactin levels and BMD (16). However, use of these medications was similar in both groups and probably did not confound our results.…”

“…2.8) (16). BMD was lower in boys with hyperprolactinemia than in boys without hyperprolactinemia, but comparisons with healthy controls were not made.…”

“…less exercise, nutritional alterations, and smoking) (48). In male children and adolescents with various psychiatric conditions, the effect of AP-induced hyperprolactinemia was investigated in one previous study (16). This study (nZ83, mean age 12 years) reported a reduced BMD in the hyperprolactinemic boys.…”

Possible mechanisms for the skeletal effects of antipsychotics in children and adolescents

“…In order to explore the tolerability of risperidone during long-term treatment in children and adolescents, Calarge and colleagues recruited 7-17 year-old patients who had received risperidone for at least 6 months [Calarge et al 2009b[Calarge et al , 2010. At study enrollment, psychotropic polypharmacy was allowed but treatment with APs other than risperidone led to study exclusion.…”

“…Little work has been conducted to directly explore skeletal health in children and adolescents receiving AP treatment. In the study cited earlier from our group, risperidone-treated participants underwent dual x-ray absorptiometry (DXA) of the lumbar spine and a peripheral quantitative computed tomography (pQCT) scan of the nondominant ultra-distal radius [Calarge et al 2010]. DXA was used because of its versatility and the availability of age-and gender-specific BMD reference values for children [Zemel et al 2004;Kelly et al 2005].…”