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Systemic corticosteroid use linked to pediatric bone fractures
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Use of inhaled corticosteroids for the treatment of pediatric asthma is not significantly associated with an increased risk in bone fractures in children; however, this correlation is present when children use systemic corticosteroids, according to a study published in JAMA Pediatrics.
“Corticosteroids directly interfere with osteoclast and osteoblast functioning, resulting in decreased bone formation, increased resorption and bone calcium loss. This can predispose corticosteroid users to osteoporosis,” Natasha Gray, MPH, from The Hospital for Sick Children in Toronto and the University of Toronto, and colleagues wrote.
“Bone health is particularly important during childhood, leaving children with asthma a potentially vulnerable population for fractures,” the researchers continued. “Concerns about the possible effects of [inhaled corticosteroids (ICSs)] may also result in poor medication adherence, leading to more frequent and severe asthma exacerbations.”
To examine the relationship between increased chances of bone fractures and ICS use in children, the researchers conducted a population-based nested case-control study in which administrative databases were used to recognize children aged between 2 and 18 years old who were diagnosed with asthma. All diagnoses were conducted by physicians between April 1, 2003, and March 31, 2014, and all children received drug coverage through the public Ontario Drug Benefit Program.
Children who had their first fractures after asthma diagnosis were compared with controls who had not experienced a fracture (1:4) who were within 1 year of the child’s date of birth. Controls were also matched based on sex and age at asthma diagnosis within 2 years. A 1-year lookback period was used to gather history of ICS use, and ORs with a 95% CI for fractures in children with any use and no use of ICSs were calculated using multivariable conditional logistic regression.
Of the 19,420 children included in the study, 61% were male and 31.5% were between the ages of 6 and 9. No notable connection between first fracture after asthma diagnosis and current use of ICSs was observed (OR = 1.07; 95% CI, 0.97-1.17) when compared with controls. Similar results were observed for recent use (OR = 0.96; 95% CI, 0.86-1.07) and past use of ICSs (OR = 1.00; 95% CI, 1.04-1.33).
Gray and colleagues noted that in the 1-year lookback period, children who used systemic corticosteroids were more likely to sustain a fracture (OR =1.17; 95% CI, 1.04-1.33).
“We excluded some conditions that might require use of systemic corticosteroids — cancer and organ transplant; thus, a large proportion of the systemic corticosteroid use in our population is likely attributable to asthma exacerbations,” the researchers wrote. “Therefore, some of the association between systemic corticosteroids and fractures may be attributed to more severe asthma. However, there is also the strong potential that systemic corticosteroids significantly increase the risk of fracture independent of disease severity, as these medications have a much higher circulating bioavailability of corticosteroids than ICSs.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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