Schlienger RG, Jick SS, Meier CR. Pediatrics. 2004;114:469–473
Purpose of the Study.
To determine if children or adolescents who are exposed to inhaled corticosteroids (ICS) (ie, beclomethasone, budesonide, fluticasone) are at a higher risk of having bone fractures compared with nonexposed individuals.
This was a population-based study using the United Kingdom General Practice Research database that contains data for >3 million people.
Within a base population of 273 456 individuals aged 5 to 79 years, the authors used International Classification of Diseases codes to identify 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 database. They compared the use of ICS steroids before the index date between fracture cases and control patients.
There was no increased fracture risk associated with current exposure to ICS when 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). For individuals with current or previous exposure to oral steroids, the adjusted odds ratio for current long-term inhaled steroid use compared with nonuse was 1.21 (95% confidence interval: 0.99, 1.49).
The conclusions of the authors were that exposure to ICS does not substantially enhance the fracture risk in children and adolescents when compared with nonexposed individuals.
This excellent study verifies general consensus in the literature that ICS used in recommended doses do not increase fracture risk in children or adolescents when compared with controls. There are some limitations to this study admitted by the authors in their discussion. For example, there is a small sample size in the individual strata, and as a result there are wide confidence intervals. Therefore, the authors could not exclude with certainty that long-term exposure to ICS might be associated with slightly increased fracture risk. More studies would be needed to better assess the impact of longer-term treatment and the use of concomitant oral steroids on fracture risks.