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PEDIATRICS Vol. 114 No. 2 August 2004, pp. 469-473

Inhaled Corticosteroids and the Risk of Fractures in Children and Adolescents

Raymond G. Schlienger, PhD*,{ddagger}, Susan S. Jick, DSc§ and Christoph R. Meier, PhD*,{ddagger}

* Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital, Basel, Switzerland
{ddagger} Institute of Clinical Pharmacy, Department of Pharmacy, University of Basel, Basel, Switzerland
§ Boston Collaborative Drug Surveillance Program, Boston University, School of Medicine, Lexington, Massachusetts

Objective. To determine whether children or adolescents who are exposed to inhaled corticosteroids (ie, beclomethasone, budesonide, fluticasone) are at a higher risk of having bone fractures compared with nonexposed individuals.

Methods. We performed a population-based nested case-control analysis using data from the United Kingdom–based General Practice Research Database. Within a base population of 273 456 individuals aged 5 to 79 years, we identified by International Classification of Diseases codes children or adolescents who were aged 5 to 17 years with a fracture diagnosis and up to 6 control subjects per case matched to cases on age, gender, general practice attended, calendar time, and years of history in the GPRD. We compared use of inhaled steroids before the index date between fracture cases and control patients.

Results. We identified 3744 cases and 21 757 matched control subjects aged 5 to 17 years. Current exposure to inhaled steroids did not reveal a substantially altered fracture risk compared with nonusers, even in individuals with current longer term exposure (ie, ≥20 prescriptions; adjusted odds ratio 1.15; 95% confidence interval: 0.89–1.48). In individuals with current or previous exposure to oral steroids, the adjusted odds ratio for current long-term inhaled steroid use compared with nonusers was 1.21 (95% confidence interval: 0.99–1.49).

Conclusions. Exposure to inhaled steroids does not materially increase the fracture risk in children or adolescents compared with nonexposed individuals.

Key Words: glucocorticoids • asthma • children • adolescents • fractures • case-control studies • epidemiology

Abbreviations: GPRD, General Practice Research Database • ICD-8, International Classification of Diseases, Eighth Revision • COPD, chronic obstructive pulmonary disease • OR, odds ratio • CI, confidence interval

Received for publication May 23, 2003; Accepted Nov 5, 2003.




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