Children with moderate persistent asthma daily inhaled corticosteroids (ICS) have less bone risk when compared to children with asthma who do not take steroids.

Natasha Gray, from The Hospital for Sick Children, wrote, clinicians prescribed ICSs to optimize childhood asthma. They should be reassured by the lack of association with fractures. Fear of fracture is not a reason to limit the therapeutic use of ICSs. The study article published in JAMA Pediatrics. The study also found the relationship between systemic steroids and significantly increased fracture risk.

Research in adults showed systemic steroids could predispose to osteoporosis and increase the risk for fracture.  The findings raised whether childhood bone health and its development have similar effects with ICSs. ICS safety in children are few, but studies on this have yielded inconsistent results.

Researchers in Ottawa, Ontario, Canada conducted a population-based case-control study to investigate the issue. Between April 2003 and March 2014, they identified 19,420 children aged 2 to 18 years (61% male) who had been diagnosed with asthma, using administrative databases.

Based on the birth date, sex, and age at asthma diagnosis researchers matched children in a ratio of 1:4. After an asthma diagnosis, 3884 children with first fracture and 15536 children with free of fracture cases were included. Then researcher had evaluated ICS use going back 1 year before fractures occurred.

There is no significant relationship between the first fracture after an asthma diagnosis and current ICS use (p=.20), recent ICS use (p=.53), or past ICS use (p=.86) compared with no ICS use. The analysis controlled for sociodemographic factors, as well as systemic steroid and other medication use. When compared to no  use of systemic steroids, Use of systemic steroids 1 year before a fracture occurred was associated with a 17% increased odds of fracture(p=.01)

Some of the association between fracture risk and systemic corticosteroids account due to severe asthma. However, severe asthma in children might have lower activity levels, which could have a detrimental effect on bone strength.

The study has limitations, in which evaluation for nutrition, disease severity, and vitamin D and calcium levels. Also, children included had to be eligible for public drug coverage via the Ontario Drug Benefit Program. The results may not generalize more widely to moderate since most of the patients are from low-income families.