Researchers in Canada determine if the use of inhaled corticosteroids in children with asthma increases the risk of bone fracture.
Inhaled corticosteroids are a gold standard in the treatment and management of asthma in children. It is well known in the adult population that oral corticosteroids taken in high doses and for long durations can affect bone mineral density. Since they must be used daily to ensure asthma control, parents often worry about the potential effects the drug may have on their children’s growth and development.
Asthma is a very common chronic respiratory condition that usually begins in childhood. Inhaled corticosteroids are effective for reducing lung inflammation and controlling asthma symptoms. Since asthma is a chronic disease, chronic use of inhaled corticosteroids is required for asthma control. A lack of adherence to treatment can cause worsening of the condition. There is concern about the potential side effects of inhaled corticosteroids since oral steroids can be associated with decreased bone density and fractures in children. Previous studies have shown conflicting evidence for an association between inhaled corticosteroids and fracture risk in children with asthma.
Researchers at The Hospital for Sick Children in Toronto, Canada conducted a population-based study including 19,420 children between the ages of two and 18 years old, who had a bone fracture after being diagnosed with asthma. Each asthmatic child with a bone fracture was matched to another asthmatic child who did not have any bone fractures. For every child with a bone fracture event in the sample population, the researchers would check if any inhaled corticosteroid was dispensed one year prior. The results of this study were published in JAMA Pediatrics on November 13, 2017.
By comparing the control and sample populations, the scientists demonstrated that current use, recent use, and past use of inhaled corticosteroids were not associated with an increased risk of bone fractures. In addition, fracture risks were not statistically significant in children using inhaled corticosteroids closer to the time of the fracture event, using high doses of inhaled corticosteroids or filling three or more prescriptions of inhaled corticosteroids in one year.
As expected, filling a prescription for an oral corticosteroid did show an increased risk of bone fractures; however, filling multiple prescriptions of oral corticosteroids did not result in any further increase in risk. This increased risk may be a consequence of the oral drug or a consequence of limited physical activity in children with more severe cases of asthma. Decreased physical activity can decrease bone strength and lead to more fractures. It is not possible at this time to draw any conclusions about oral corticosteroids and their risk of bone fractures in children.
Asthma control often requires taking inhaled corticosteroids every day and, in some cases, several times a day. Improper use of inhaled corticosteroids may result in exacerbations of asthma symptoms and a possible need for oral corticosteroids, which may have a negative effect on bone health. The findings from this comprehensive study allow parents to feel confident that the inhaled corticosteroids their children use to manage their asthma symptoms are safe for chronic use.
Written by Jessica Caporuscio, PharmD
Reference: Gray N, Howard A, Zhu J, et al. Association Between Inhaled Corticosteroid Use and Bone Fracture in Children With Asthma. JAMA Pediatr. 2017.
