Impact of Inhaled Corticosteroids on Bone Fracture Risk in Children with Asthma
Introduction to Inhaled Corticosteroids
Inhaled corticosteroids are the standard treatment for managing asthma in children. While their effectiveness in controlling asthma symptoms and reducing lung inflammation is well-established, concerns exist regarding their potential impact on children’s growth and development. This is particularly relevant given the known effects of oral corticosteroids, which can decrease bone mineral density when used in high doses over extended periods.
Understanding Asthma in Children
Asthma is a prevalent chronic respiratory condition that frequently emerges during childhood. Due to its chronic nature, daily use of inhaled corticosteroids is often necessary to maintain control over the condition. Non-adherence to treatment can lead to exacerbations, prompting concerns about the side effects of these medications, especially regarding bone health and fracture risk.
Conflicting Evidence on Fracture Risk
Previous studies have produced mixed results regarding the association between inhaled corticosteroids and fracture risk in children. To address this uncertainty, researchers at The Hospital for Sick Children in Toronto, Canada, undertook a population-based study involving 19,420 children aged 2 to 18 years who experienced bone fractures following an asthma diagnosis.
Study Design and Findings
In this study, each child with a bone fracture was matched with another child with asthma who had not sustained a fracture. The researchers investigated whether any inhaled corticosteroid was dispensed within a year prior to the fracture event. The findings were published in JAMA Pediatrics on November 13, 2017.
The comparison between the two groups revealed that current, recent, and past use of inhaled corticosteroids did not correlate with an increased risk of bone fractures. Additionally, the data showed no statistically significant fracture risks associated with the use of high doses of inhaled corticosteroids or with children filling three or more prescriptions in one year.
Oral Corticosteroids and Bone Fracture Risk
Conversely, the study indicated that filling a prescription for oral corticosteroids was linked to an increased risk of bone fractures. However, multiple prescriptions for oral corticosteroids did not further elevate this risk. This increased fracture risk may stem from either the effects of the oral medication or decreased physical activity commonly observed in children with more severe asthma, which can weaken bone strength.
Conclusion and Implications for Parents
Managing asthma often necessitates daily inhaled corticosteroid use, and improper administration can lead to worsened symptoms requiring oral corticosteroids, which may adversely affect bone health. The results of this comprehensive study provide reassurance to parents that the inhaled corticosteroids prescribed for their children to control asthma symptoms are safe for long-term use.
Author and Reference
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.