Daily use of inhaled corticosteroids does not increase the risk of bone fracture in children with asthma, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES) and The Hospital for Sick Children (SickKids).

Inhaled corticosteroids are medications used to treat asthma. They are taken by using an inhaler. It is recommended that this medication be taken consistently to decrease inflammation in the airways of the lungs and prevent asthma flare-ups. Inhaled corticosteroids are considered the most effective long-term usage medication for control and management of asthma.


The researchers did this study because 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.

“Our results show that the use of inhaled corticosteroids for the treatment of pediatric asthma should not be limited based on fear of fracture,” says Dr. Teresa To, scientist at ICES and the research institute at SickKids.

In the study published today in JAMA Pediatrics, researchers examined data representing 19,420 Ontario children aged 2 to 18 and did not find any significant associations between current, recent or past use of inhaled corticosteroids and first fracture in children after an asthma diagnosis.

“While our study results are reassuring since we found no clinically important association between inhaled corticosteroids and fracture among children with asthma; we did find that nearly 50 per cent 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,” adds To.

The researchers add that future work 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.

The study is an example of how SickKids and ICES are contributing to making Ontario Healthier, Wealthier and Smarter.

“Association between inhaled corticosteroid use and bone fracture in children with asthma,” was published today in JAMA Pediatrics.

Author block: Natasha Gray, Andrew Howard, Jingqin Zhu, Laura Y. Feldman and Teresa To.