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Are inhaled corticosteroids associated with an increased risk of fracture in children?

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Abstract

Inhaled corticosteroids are widely used in the long-term management of asthma in children. Data on the relationship between inhaled corticosteroid therapy and osteoporotic fracture are inconsistent. We address this issue in a large population-based cohort of children aged 4–17 years in the UK (the General Practice Research Database). The incidence rates of fracture among children aged 4–17 years taking inhaled corticosteroids (n=97,387), taking bronchodilators only (n=70 984) and a reference group (n=345,758) were estimated. Each child with a non-vertebral fracture (n=23,984) was subsequently matched by age, sex, practice, and calendar time to one child without a fracture. Fracture incidence was increased in children using inhaled corticosteroids, as well as in those receiving bronchodilators alone. With an average daily beclomethasone dose of 200 μg or less, the crude fracture risk relative to nonusers was 1.10 [95% confidence interval (CI), 0.96–1.26]; with dosage of 201–400 μg, it was 1.23 (95% CI, 1.08–1.39); and with dosages over 400 μg, it was 1.36 (95% CI, 1.11–1.67). This excess risk disappeared after adjustment for indicators of asthma severity. The increased risk of fracture associated with use of inhaled corticosteroids is likely to be the result of the underlying illness, rather than being directly attributable to inhaled corticosteroid therapy.

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Acknowledgements

Procter & Gamble Pharmaceuticals funded the study. We thank EPIC for their support in providing the GPRD data. N.J. Bishop and C. Cooper are supported by the Arthritis Research Campaign.

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Authors and Affiliations

  1. MRC Epidemiology Resource Centre, University of Southampton, Southampton, SO16 6YD, UK

    Tjeerd-Pieter van Staa & Cyrus Cooper

  2. Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Sorbonnelaan 16, Utrecht, The Netherlands

    Tjeerd-Pieter van Staa & Hubert G. M. Leufkens

  3. Procter & Gamble Pharmaceuticals, Rusham Park, Egham, UK

    Tjeerd-Pieter van Staa

  4. Academic Child Health, Sheffield University, Sheffield, UK

    Nick Bishop

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  1. Tjeerd-Pieter van Staa
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  2. Nick Bishop
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  3. Hubert G. M. Leufkens
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  4. Cyrus Cooper
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Correspondence to Cyrus Cooper.

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van Staa, TP., Bishop, N., Leufkens, H.G.M. et al. Are inhaled corticosteroids associated with an increased risk of fracture in children?. Osteoporos Int 15, 785–791 (2004). https://doi.org/10.1007/s00198-004-1606-5

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  • DOI: https://doi.org/10.1007/s00198-004-1606-5

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