No Link Found Inhaled Steroids and Bone Fractures in Asthmatic Children Interview with:
“Asthma” by Michael Havens is licensed under CC BY 2.0Teresa To, PhD
Biostatistics, Design and Analysis
Scientific Director
The Hospital for Sick Children
Dalla Lana School of Public Health, University of Toronto
Institute for Clinical Evaluative Sciences
Toronto, Ontario, Canada What is the background for this study? What are the main findings?

Response: We studied asthma prescription drug use in Ontario children aged 2 to 18 years with physician diagnosed asthma between 2003 and 2014.

We found that:

  1. Currently in Ontario, nearly 50% of children with asthma did not fill a prescription for an inhaled corticosteroid during the study period, despite these medications being considered the gold-standard for asthma management.
  2. Our findings did not show clinically important association between inhaled corticosteroids and fracture among children with asthma.
  3. However, systemic corticosteroids (oral or injection) are associated with higher fracture risk in children with asthma (17% higher risk). What should clinicians and patients take away from your report?

Response: The use of inhaled corticosteroids, (gold-standard treatment for asthma) to treat children with asthma should not be limited based on fear of fracture.

In fact, underuse of inhaled corticosteroids may lead to worsening of asthma symptoms that may increase the risk of asthma exacerbations that ultimately require the use of systemic steroids that are associated with higher bone risk. What recommendations do you have for future research as a result of this study?

Response: Future research should investigate how severity of asthma may play a role in the risk of fracture, as some of the increased risk associated with systemic corticosteroids may be due to the underlying illness itself. Thank you for your contribution to the community.


Gray N, Howard A, Zhu J, Feldman LY, To T. Association Between Inhaled Corticosteroid Use and Bone Fracture in Children With Asthma. JAMA Pediatr. Published online November 13, 2017. doi:10.1001/jamapediatrics.2017.3579

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 14, 2017 by Marie Benz MD FAAD