Inhaled steroids don't up kids' fracture risk much

Children and adolescents who use inhaled corticosteroids to treat asthma do not have a significantly increased risk of suffering bone fractures, researchers report.

However, "there does seem to be a small, but not substantial fracture risk elevation for children using inhaled steroids on a longer-term basis," senior investigator Dr. Christoph R. Meier, of University Hospital in Basel, Switzerland, told AMN Health.

Steroids reduce chronic inflammation but they are known to have a bone-thinning effect, which is one reason why high oral doses are prescribed for only short periods. Whether the drugs have an adverse effect when they're inhaled is less clear.

Meier and colleagues analyzed data from the UK's General Practice Research Database, which contained information on 273,456 individuals. The investigators identified 3744 subjects between 5 and 17 years old who had had a fracture, and compared them with 21,757 matched "control" subjects.

There was no significant increase in fracture risk in inhaled corticosteroid users, even among those with longer-term exposure, the team reports in the medical journal Pediatrics. Among individuals who had filled 20 or more prescriptions for steroid inhalers, the odds of a fracture were just 15 percent higher than for the control group.

For people who had used both oral steroids and inhaled corticosteroid, the odds were raised 21 percent.

Thus, Meier concluded, "it is reassuring to get evidence that even longer-term use of inhaled steroids, which is crucial to control asthma, does not seem to cause substantial adverse effects on bones."

SOURCE: Pediatrics, August 2004.