Asthma, bones and corticosteroids: Are inhaled corticosteroids associated with fractures in children with asthma?

Zieck, Saskia E.; George, Johnson; Blakeley, Brooke A.; Welsh, Liam; Liu, James N. K.; Ranganathan, Sarath; Simm, Peter; Lim, Alan T.

doi:10.1111/jpc.13554

Cited by 8 publications

(11 citation statements)

References 21 publications

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“…Low‐energy fractures may result from diseases that affect bone integrity . The findings of Western studies on the association between ICSs and the risk of osteoporosis and fractures are equivocal, with the results varying depending on the study population, study design and the evaluated ICS dose . However, studies on the relationship between ICSs and the risk of low‐energy fractures in patients with chronic airway diseases in an Asian population are lacking.…”

Section: Introductionmentioning

confidence: 75%

“…12,13 The findings of Western studies on the association between ICSs and the risk of osteoporosis and fractures are equivocal, with the results varying depending on the study population, study design and the evaluated ICS dose. [14][15][16][17][18][19] However, studies on the relationship between ICSs and the risk of low-energy fractures in patients with chronic airway diseases in an Asian population are lacking. Hence, we conducted a propensity score matched cohort study to evaluate whether ICS use increases the risk of fracture.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Inhaled corticosteroids and the risks of low‐energy fractures in patients with chronic airway diseases: A propensity score matched study

Tsai

Liao

Lin

et al. 2017

Clinical Respiratory J

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Section: Introductionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Inhaled corticosteroids and the risks of low‐energy fractures in patients with chronic airway diseases: A propensity score matched study

Tsai

Liao

Lin

et al. 2017

Clinical Respiratory J

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“…17 Zeick et al also studied children with asthma and revealed that inhaled corticosteroid was not associated with fracture risk in these patients. 4 The difference between previous studies might be, to some extent, due to difference in patient selection. In our study, we had a very rigid selection criterion in an attempt to exclude the patients with chronic obstructive pulmonary disease, smoking, and those with other chronic inflammatory diseases.…”

Section: Resultsmentioning

confidence: 98%

“…1 The effect of systemic corticosteroids on decreasing bone mineral density (BMD) was investigated and confirmed in children 2,3 ; however, the effect of ICSs on bone density has still remained unclear. 4 Some previous reports showed that prolonged treatment with inhaled steroids in children and adolescence with moderate to severe asthma did not have adverse effects on the bone mineral density. [5][6][7][8] However, few studies showed that children with asthma had lower total body BMD, 9,10 and BMD reduction in these patients depends on age, 11 dose of inhaled corticosteroid used in these children, 12 and genetic factors.…”

Section: Introductionmentioning

confidence: 97%

Evaluation of vitamin D deficiency and low bone mass in children with asthma in fars province: A case‐control study

Alyasin,

Sadeghi,

Saki

et al. 2024

Health Science Reports

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Background and AimsAsthma is a chronic inflammatory pulmonary disease which affects 10%–20% of children and adolescents. Inhaled corticosteroids (ICS) is one of its most effective therapies. The effect of systemic corticosteroids on decreasing bone mineral density (BMD) was investigated and proved in children; however, the influence of ICSs on bone density has still remained unclear. This study evaluates the bone mineral density of children and adolescents with asthma in southern Iran and the associated factors, for example, amount of used inhaled steroid.MethodThis case‐control study enrolled 41 children and adolescents (aged 8–18 years) with asthma and their age and gender‐matched controls in 2019–2020. Serum Calcium, phosphate, vitamin D, and bone mineral density were measured. Their physical activity, sun exposure, and fracture history were evaluated subjectively.ResultsLumbar BMD and BMD Z‐score in patients showed no significant difference with controls (p = 0.23, p = 0.73). Also, it showed that there was no significant difference in biochemical studies, growth, and bone densitometry parameters between patients who used ICSs for less than 3 months/year corticosteroid therapy compared to those with equal or more than 3 months/year usage. Prevalence of vitamin D deficiency was 28% and 8% in the controls and patients, respectively (p = 0.005).ConclusionThe present study showed that 9.46% of children and adolescents with asthma had low bone mass for chronological age, and it is not significantly higher than normal population. Dosage of inhaled steroid did not associate with osteoporosis in these patients. Prevalence of vitamin D deficiency in patients was lower than normal population, probably due to receiving vitamin D in their routine follow‐ups.

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“…For inhaled steroid use in children, commonly prescribed for asthma, most studies have not found effects of inhaled steroid use on bone markers[41–43], although a few have identified decreased BMD with high dose inhaled corticosteroids[44]. It is unclear if there is confounding as better control of asthma leads to greater physical activity, which is beneficial to bone development.…”

Section: Special Consideration: Children On Steroidsmentioning

confidence: 99%

Advances in treatment of glucocorticoid-induced osteoporosis

Hsu

Nanes

2017

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of Review To summarize monitoring, prevention, and treatment options of glucocorticoid-induced osteoporosis for patients on chronic glucocorticoid therapy. Recent Findings Recent meta-analyses highlight the efficacy of bisphosphonate use in improving bone mineral density and in reducing vertebral fractures in the setting of long term glucocorticoid use. A new study has now shown that alendronate also reduces the risk of hip fracture in glucocorticoid use. Emerging data indicate that teriparatide and denosumab also reduce the risk of osteoporotic fracture in glucocorticoid-induced osteoporosis. Summary Glucocorticoid use is a leading cause of secondary osteoporosis; however, patients at risk of glucocorticoid-induced osteoporosis are often not evaluated or treated in a timely manner. Patients on a dose equivalent of 2.5mg prednisone or greater for 3 months or longer duration should have their fracture risk assessed. Those at moderate or high risk should start bisphosphonate therapy, or if contraindicated, a second line agent such as teriparatide or denosumab.

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Asthma, bones and corticosteroids: Are inhaled corticosteroids associated with fractures in children with asthma?

Abstract: ICS use was not associated with fracture risk in children with asthma.

Cited by 8 publications

References 21 publications

Inhaled corticosteroids and the risks of low‐energy fractures in patients with chronic airway diseases: A propensity score matched study

Inhaled corticosteroids and the risks of low‐energy fractures in patients with chronic airway diseases: A propensity score matched study

Evaluation of vitamin D deficiency and low bone mass in children with asthma in fars province: A case‐control study

Advances in treatment of glucocorticoid-induced osteoporosis

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