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Autism, Fractures and Psychiatric Medication

A study which used data from the National Emergency Department Sample database which consists of information from over 28 million emergency department visits at 961 hospitals, showed that "[p]eripubertal boys with autism spectrum disorder have lower bone mineral density than typically developed controls." (Ann M. Neumeyer, Julia A. O'Rourke and Madhusmita Misra, "Brief Report: Bone Fractures in Children and Adults with Autism Spectrum Disorders," Journal of Autism and Developmental Disorders, 45, No. 3 (March 2015): 881-887, doi: 10.1007/s10803-014-2228-1). Both male and female children and adults with autism had a significantly increased risk of hip fractures Furthermore, adult women with autism had a higher risk of forearm and spine fractures compared to controls. The study further discusses that hip fractures in particular often require surgery and can cause life-long disability and individuals with autism may have more difficulty adhering to treatment including rehabilitation. In addition, individuals with autism may not understand risk and be more prone to accidents. Interestingly, another study showed peripubertal boys with autism on gluten- and casein- free diets have even lower bone mineral density, Ann M. Neumeyer, Amy Gates, Christine Ferrone, Hang Lee and Madhusmita Misra, "Bone Density in Peripubertal Boys with Autism Spectrum Disorders," Journal of Autism and Developmental Disorders, 43, No. 7 (July 2013): 1623-1629, doi: 1007/s10803-012-1709-3). What is concerning is that a recent study involving 68,730 individuals, demonstrated a significantly increased risk of hip and nontraumatic major osteoporotic fractures in individuals on psychiatric medications, including selective serotonin reuptake inhibitors, antipsychotics and benzodiazepines, (James M. Bolton, Suzanne N. Morin, Sumit R. Majumdar, "Associations of Mental Disorders and Related Medication Use with Risk for Major Osteoporotic Fractures, JAMA Psychiatry, published online (April 19, 2017): doi: 10.1001/jamapsychiatry.2017.0449). All these types of medications are commonly prescribed in individuals with autism spectrum disorders, which may further increase the risk for fractures in this population which is already at an increased risk.