Abstract
ObjectiveAntipsychotics may increase serum prolactin, which has particularly been observed with risperidone. Further, hyperprolactinemia has been linked to osteoporosis‐related fractures. Therefore, we investigated fracture risk in a nationwide cohort exposed to antipsychotics.MethodsSwedish registers were used to identify adults with two consecutive dispensations of risperidone (n = 38 211), other atypical antipsychotics not including paliperidone (n = 60 691), or typical antipsychotics (n = 17 445) within three months between 2006 and 2013. An osteoporosis‐related fracture was defined as a non‐open hip/femur fracture in primary analyses. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsRisperidone users were on average older (mean age of 68, 44, and 63 years for risperidone, other atypical antipsychotics, and typical antipsychotics respectively). Compared with other atypical antipsychotics, there was no association between risperidone and osteoporosis‐related fractures in the overall (HR = 1.04, CI: 0.91–1.19) or age‐stratified analyses. A significantly increased risk of typical antipsychotics (HR = 1.24, CI: 1.07–1.45) compared with other atypical antipsychotics remained for ages >45 years.ConclusionRisperidone does not appear to be associated with an increased risk of osteoporosis‐related fracture compared with other atypical antipsychotic agents as a group. For typical antipsychotics, a moderately elevated risk of hip fractures was noted compared with other atypical antipsychotics, possibly because of residual confounding.
Highlights
It is well known that the use of antipsychotic agents can cause elevated levels of circulating prolactin, because of their antidopaminergic activity affecting the tuberoinfundibular pathway [1]
The study included 38 211 individuals exposed to risperidone, 60 691 individuals exposed to other atypical antipsychotics, and 17 445 individuals exposed to typical antipsychotics (Table 1)
This study indicates that compared with other atypical antipsychotic agents, risperidone use is not associated with an elevated risk of osteoporosis-related fractures
Summary
It is well known that the use of antipsychotic agents can cause elevated levels of circulating prolactin, because of their antidopaminergic activity affecting the tuberoinfundibular pathway [1]. Some epidemiological studies suggest a possible link between an elevated prolactin level and an increased risk of osteoporosis-related fractures [1, 3]. Risperidone is an atypical antipsychotic agent featuring antagonistic effects of the dopamine type 2 and serotonin type 2A receptors. It is associated with a greater and more frequent elevation of circulating prolactin level compared with other atypical antipsychotics [4, 5], and because of this fact, there has been a concern that risperidone may be associated with an increased risk of osteoporosis-related fractures. The risk of fractures might be elevated among users of antipsychotics for reasons other than osteoporosis induced by hyperprolactinemia. In early 2017, the U.S Food and Drug Agency approved a labeling update for all antipsychotic medications stating that antipsychotic drugs may cause somnolence, postural hypotension, and motor and sensory instability, which may lead to falls and, fractures or other injuries [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
