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We included ASD children aged 2\u201318\u2009years, 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\u2010up were evaluated, and the risk between aripiprazole and risperidone was compared via Cox\u2010proportional hazard models. Results were stratified by age, sex, duration of exposure and fracture site. In total, 3312 patients (78% male; mean [<jats:italic>SD<\/jats:italic>] age 11.0 [3.7] years) were identified for each cohort. Over the full duration of follow\u2010up, fracture incidence rates per 1000 patient\u2010years were 23.2 for risperidone and 38.4 for aripiprazole (hazard ratio and 95% confidence interval: 0.60 [0.44\u20130.83]). Risks were similar between cohorts throughout the first 180\u2009days 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\u2009years or younger (HR [95% CI]: 0.47 [0.30\u20130.74]). In conclusion, compared to aripiprazole, risperidone was associated with 40% lower risk of fracture. Further analysis on the mechanism and long\u2010term bone health of antipsychotic\u2010treated children with ASD is warranted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Lay summary<\/jats:title><jats:p>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\u2009days 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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/aur.2541","type":"journal-article","created":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T09:10:05Z","timestamp":1622797805000},"page":"1800-1814","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Risperidone versus aripiprazole fracture risk in children and adolescents with autism spectrum disorders"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3708-0393","authenticated-orcid":false,"given":"Richard","family":"Houghton","sequence":"first","affiliation":[{"name":"Personalized Health Care Data Science F. 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