ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: JAMA Pediatr 2018;172:57-64

Corticosteroids are a well-known risk factor for compromised bone health. There have been concerns regarding the use of inhaled corticosteroids in children with asthma. It is often stated that poor disease control is a greater risk for bones than the medication itself. The evidence however has not been overwhelming. Corticosteroids directly interfere with osteoclast and osteoblast functioning, resulting in decreased bone formation, increased resorption, and calcium loss from the skeleton. This can predispose corticosteroid users to osteoporosis and increased risk of bone fracture. The primary objective of this study was to determine the association between inhaled corticosteroid use and first fracture after asthma diagnosis in children. The study population comprised of 19,420 children with asthma who were eligible for public drug coverage through the Ontario Drug Benefit Program in Ontario, Canada.

This population-based study demonstrated no clinically important association between inhaled corticosteroids and fracture in children with asthma. However, there was an increased risk of fracture associated with systemic corticosteroid use. Clinicians using inhaled corticosteroids to optimize the control of childhood asthma should be reassured by the lack of association with fractures. Fear of fracture is not a reason to limit the use of inhaled corticosteroids. In fact, good asthma control might decrease the likelihood of asthma exacerbations and need for systemic corticosteroids. This in turn may potentially lead to a reduced fracture risk.