{"id":3479,"date":"2017-11-13T00:00:00","date_gmt":"2017-11-13T05:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/association-between-inhaled-corticosteroid-use-and-bone-fracture-in-children-with-asthma\/"},"modified":"2023-06-14T20:03:44","modified_gmt":"2023-06-15T00:03:44","slug":"association-between-inhaled-corticosteroid-use-and-bone-fracture-in-children-with-asthma","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/association-between-inhaled-corticosteroid-use-and-bone-fracture-in-children-with-asthma\/","title":{"rendered":"Association between inhaled corticosteroid use and bone fracture in children with asthma"},"content":{"rendered":"<p><strong>Importance<\/strong> &#x2014; Daily use of inhaled corticosteroids is a widely recommended treatment for mild persistent asthma in children. There is concern that, similar to systemic corticosteroids, inhaled corticosteroids may have adverse effects on bone health.<\/p>\n<p><strong>Objective<\/strong> &#x2014; To determine whether there is an increased risk of bone fracture associated with inhaled corticosteroid use in children with asthma.<\/p>\n<p><strong>Design<\/strong> &#x2014; In this nested case-control study, we utilized health administrative databases from 2003&#x2013;2014 to identify a cohort of children with physician-diagnosed asthma. We matched cases of first fracture after asthma diagnosis to fracture-free controls (1:4) based on date of birth (within 1 year), sex and age at asthma diagnosis (within 2 years). We used a one-year lookback period to ascertain history of inhaled corticosteroid use. Multivariable conditional logistic regression was used to obtain an odds ratio with 95% confidence interval for fracture, comparing no inhaled corticosteroid use to current, recent and past use.<\/p>\n<p><strong>Setting<\/strong> &#x2014; Population-based study in Ontario, Canada.<\/p>\n<p><strong>Participants<\/strong> &#x2014; Children aged 2-18 years with a physician diagnosis of asthma between 2003 and 2014 eligible for public drug coverage through the Ontario Drug Benefit program.<\/p>\n<p><strong>Main Exposure<\/strong> &#x2014; Inhaled corticosteroid use during the child&#x2019;s one-year lookback period, measured as current use if prescription was filled &lt;90 days prior to index date, recent user (91-180 days), past user (181-365 days), or no use.<\/p>\n<p><span class=\"bold\">Main Outcome and Measurements<\/span> &#x2014; First emergency department visit for fracture after asthma diagnosis, identified using ICD-10 codes.<\/p>\n<p><strong>Results<\/strong> &#x2014; In the 19,420 children included, the multivariable regression results did not show a significant association between first fracture after asthma diagnosis and current (OR: 1.07, 95% CI: 0.97-1.17), recent (OR: 0.96, 95% CI: 0.86-1.07), or past use (OR: 1.00, 95% CI: 0.91-1.11) of inhaled corticosteroids, compared to no use, while adjusting for sociodemographic factors and other medication use. However, use of systemic corticosteroids in the year lookback period resulted in a significantly greater odds of fracture (OR: 1.17, 95% CI: 1.04-1.33).<\/p>\n<p><span class=\"bold\">Conclusion and Relevance<\/span> &#x2014; Systemic corticosteroids, but not inhaled corticosteroids, were significantly associated with an increased odds of fracture in the pediatric asthma population.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Importance &#x2014; Daily use of inhaled corticosteroids is a widely recommended treatment for mild persistent asthma in children. There is concern that, similar to systemic corticosteroids, inhaled corticosteroids may have adverse effects on bone health. Objective &#x2014; To determine whether there is an increased risk of bone fracture associated with inhaled corticosteroid use in children [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-3479","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"Gray N, Howard A, Zhu J, Feldman LY, To T. <em>JAMA Pediatr. <\/em>2018; 172(1):57-64. Epub 2017 Nov 13.","source_url":"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/fullarticle\/2661821","ices_scientist":[1111],"site":[6735],"research_program":[6746],"news_release":[7618],"journal_article":[],"atlas":[],"research_report":[],"infographic":[9441],"video":[],"downloads":null,"links":null,"sitecore_item_id":"620AE23D-E8E7-433C-9713-CF2DD24A77DF","sitecore_item_name":"Association-between-inhaled-corticosteroid-use-and-bone-fracture-in-children-with-asthma","sitecore_field_values":"{\n  \"__Valid from\": \"20171114T111426\",\n  \"Title\": \"Association between inhaled corticosteroid use and bone fracture in children with asthma\",\n  \"Short title\": \"Association between inhaled\",\n  \"Summary\": \"The researchers studied whether there is an increased risk of bone fracture associated with inhaled corticosteroid use in children with asthma.\",\n  \"Citation\": \"<p>Gray N, Howard A, Zhu J, Feldman LY, To T. <em>JAMA Pediatr. <\/em>2018; 172(1):57-64. Epub 2017 Nov 13.<\/p>\",\n  \"Abstract\": \"<p><strong>Importance<\/strong> &mdash; Daily use of inhaled corticosteroids is a widely recommended treatment for mild persistent asthma in children. There is concern that, similar to systemic corticosteroids, inhaled corticosteroids may have adverse effects on bone health.<\/p>n<p><strong>Objective<\/strong> &mdash; To determine whether there is an increased risk of bone fracture associated with inhaled corticosteroid use in children with asthma.<\/p>n<p><strong>Design<\/strong> &mdash; In this nested case-control study, we utilized health administrative databases from 2003&ndash;2014 to identify a cohort of children with physician-diagnosed asthma. We matched cases of first fracture after asthma diagnosis to fracture-free controls (1:4) based on date of birth (within 1 year), sex and age at asthma diagnosis (within 2 years). We used a one-year lookback period to ascertain history of inhaled corticosteroid use. Multivariable conditional logistic regression was used to obtain an odds ratio with 95% confidence interval for fracture, comparing no inhaled corticosteroid use to current, recent and past use.<\/p>n<p><strong>Setting<\/strong> &mdash; Population-based study in Ontario, Canada.<\/p>n<p><strong>Participants<\/strong> &mdash; Children aged 2-18 years with a physician diagnosis of asthma between 2003 and 2014 eligible for public drug coverage through the Ontario Drug Benefit program.<\/p>n<p><strong>Main Exposure<\/strong> &mdash; Inhaled corticosteroid use during the child&rsquo;s one-year lookback period, measured as current use if prescription was filled &lt;90 days prior to index date, recent user (91-180 days), past user (181-365 days), or no use.<\/p>n<p><span class=\"bold\">Main Outcome and Measurements<\/span> &mdash; First emergency department visit for fracture after asthma diagnosis, identified using ICD-10 codes.<\/p>n<p><strong>Results<\/strong> &mdash; In the 19,420 children included, the multivariable regression results did not show a significant association between first fracture after asthma diagnosis and current (OR: 1.07, 95% CI: 0.97-1.17), recent (OR: 0.96, 95% CI: 0.86-1.07), or past use (OR: 1.00, 95% CI: 0.91-1.11) of inhaled corticosteroids, compared to no use, while adjusting for sociodemographic factors and other medication use. However, use of systemic corticosteroids in the year lookback period resulted in a significantly greater odds of fracture (OR: 1.17, 95% CI: 1.04-1.33).<\/p>n<p><span class=\"bold\">Conclusion and Relevance<\/span> &mdash; Systemic corticosteroids, but not inhaled corticosteroids, were significantly associated with an increased odds of fracture in the pediatric asthma population.<\/p>n<p><a href=\"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/fullarticle\/2661821\" title=\"opens external link\">View full text<\/a><\/p>\",\n  \"Research Programs\": \"{CFE36C89-C969-4C23-B5E4-1BA9E5BDC273}\",\n  \"ICES Locations\": \"{FBE2D1B1-C0BA-423F-8D16-39466B6C1424}\",\n  \"ICES Scientists\": \"{198CB764-0CEA-499E-A508-1CAAAD283C90}\",\n  \"Posted Date\": \"20171113T000000\",\n  \"Show on Publications Landing Page\": \"1\",\n  \"In The News\": \"{8BEC2C48-CFF4-4FFD-9E39-3BD9DB27F366}\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2017\/November\/Association-between-inhaled-corticosteroid-use-and-bone-fracture-in-children-with-asthma"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Association between inhaled corticosteroid use and bone fracture in children with asthma<\/title>\n<meta name=\"description\" content=\"Importance &#x2014; Daily use of inhaled corticosteroids is a widely recommended treatment for mild persistent asthma in children. 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