Inhaled Corticosteroid Use and Fracture Risk in Pediatric Asthma

Multiple asthma inhalers
Multiple asthma inhalers
A population-based study aimed to determine whether inhaled corticosteroid use increased risk of fracture in children with asthma.

Increased odds of fractures in pediatric patients with asthma may be associated with systemic corticosteroid use, but not with inhaled corticosteroid (ICS) use, according to a study published in JAMA Pediatrics.

Researchers identified a cohort of 19,420 children (3884 case study participants and 15,536 control cases), between 2 and 18 years of age with a diagnosis of asthma, using health administrative databases in Ontario, Canada. Participants were required to be eligible for public drug coverage through the Drug Benefit Program and have filled more than 1 prescription through a publicly funded drug plan during the 1-year look-back period of the study. The primary objective of the study was to determine the association between first fracture after a diagnosis of asthma in children and the use of ICS.

Multivariable regression analyses demonstrated no significant association between first fracture occurrence after asthma diagnosis and current use (odds ratio [OR], 1.07; 95% CI, 0.97-1.17), recent use (OR, 0.96; 95% CI, 0.86-1.07), or past use (OR, 1.00; 95% CI, 0.91-1,11) of ICS compared with no use of ICS. 

A greater risk for fracture was found during the 1-year look-back period in patients treated with systemic corticosteroids (OR, 1.17; 95% CI, 1.04-1.33). 

Investigators concluded that there was no clinically significant association between ICS and fracture risk in pediatric patients with asthma. However, an increased risk for fracture was associated with the use of systemic corticosteroids. Therefore, clinicians can both confidently and reassuringly use ICS to maintain asthma control in pediatric patients with asthma, as there is a lack of an association between its use and fractures.

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Further, proper asthma control in pediatric patients with asthma via ICS may decrease asthma exacerbations that require treatment with systemic corticosteroids, which increase the risk for fractures in this patient population.


Gray N, Howard A, Zhu J, Feldman LY, To T. Association between inhaled corticosteroid use and bone fracture in children with asthma [published online on November 13, 2017]. JAMA Pediatrics. doi:10.1001/jamapediatrics.2017.3579