Inhaled steroids and fracture risk

Children and adolescents who use inhaled corticosteroids to treat asthma do not have an increased risk of suffering bone fractures. However, there does seem to be a small increase of fracture risk in children using inhaled steroids on a long-term basis. 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.Researchers from the University Hospital in Basel, Switzerland, analysed data from 273,456 individuals. The investigators identified 3,744 subjects between 5 and 17 years old who had suffered a fracture, and compared them with 21,757 matched controls. There was no significant increase in fracture risk in inhaled corticosteroid users, even among those with long-term exposure. 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.

It is reassuring to have evidence that even long-term use of inhaled steroids, which is crucial in asthma management, does not seem to cause substantial adverse effects on bones.