title: Longitudinal examination of the skeletal effects of selective serotonin reuptake inhibitors and risperidone in boys.
abstract: OBJECTIVE
  In a previous cross-sectional study, we found lower bone mass during treatment with selective serotonin reuptake inhibitors (SSRIs) and risperidone in youths. Here, we evaluate the skeletal effects of these psychotropics at follow-up.
  
  
  METHODS
  Between April 2005 and July 2011, medically healthy 7- to 17-year-old males treated with risperidone for 6 months or more were enrolled through child psychiatry outpatient clinics and returned for follow-up 1.5 years later. Treatment history was extracted from the medical and pharmacy records. Anthropometric, laboratory, and bone mass measurements were obtained. Multivariable linear regression analyses compared participants who remained on risperidone at follow-up to those who had discontinued risperidone treatment as well as SSRI-treated versus SSRI-unexposed participants.
  
  
  RESULTS
  The sample consisted of 94 boys with a mean age of 11.8 ± 2.7 years at study entry. The majority had an externalizing disorder and had received risperidone and SSRIs for 2.5 ± 1.7 years and 1.6 ± 1.9 years, respectively, at study entry. By follow-up, 26% (n = 24) had discontinued risperidone. Compared to discontinuing risperidone, continuing it was associated with a decline in participants' age-sex-height-race-specific areal bone mineral density (BMD) z score at the lumbar spine (P < .04) and failure to increase radius trabecular volumetric BMD (P < .03), after accounting for significant covariates. In addition, receiving an SSRI was associated with reduced lumbar spine areal BMD z score and radius trabecular volumetric BMD at both study entry (P < .02 and P < .03, respectively) and follow-up (P < .06 and P < .03, respectively), but without further decline between the 2 visits.
  
  
  CONCLUSIONS
  Chronic SSRI treatment in children and adolescents is associated with reduced, albeit stable, bone mass for age, while chronic risperidone treatment is associated with failure to accrue bone mass.
authors.affiliation: Baylor College of Medicine, Texas Children's Hospital, 1102 Bates Ave, Suite 790, Houston, TX 77030 chadi.calarge@bcm.edu.
authors.forename: Chadi A
authors.initials: CA
authors.lastname: Calarge
authors.forename: Trudy L
authors.initials: TL
authors.lastname: Burns
authors.forename: Janet A
authors.initials: JA
authors.lastname: Schlechte
authors.forename: Babette S
authors.initials: BS
authors.lastname: Zemel
mesh_terms: D000293:Adolescent; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy; D015519:Bone Density / Q000187:drug effects*; D002648:Child; D006801:Humans; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D011859:Radiography; D018967:Risperidone / Q000009:adverse effects*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
chemical_list: D018967:Risperidone; D017367:Selective Serotonin Reuptake Inhibitors