Association between corticosteroid use and fracture risk in children with asthma: A nationwide cohort study.

Abstract

Background: Pediatric asthma, as a chronic inflammatory condition, has been associated with increased fracture risk due to persistent inflammation and corticosteroid treatment. This study investigates the association between pediatric asthma and fracture risk using data from the National Health Insurance Service database of South Korea.

Methods: Children born from 2002 to 2004 were selected for the analysis, utilizing information from the Korean National Health Insurance Service National Sample Cohort up to 2019. Exclusion criteria included asthma diagnosis before age 6, history of prior fractures, and the presence of severe comorbidities. Asthma cases were identified by the Korean Standard Classification of Diseases, 8th Revision (KCD-8) codes J45 and J46, and fractures were determined using all relevant KCD-8 codes. Propensity score matching was used to balance demographic and clinical characteristics between the asthma and non-asthma groups. Fracture risk was analyzed using logistic regression models adjusted for covariates. Within the asthma cohort, the analysis investigated corticosteroid exposure, focusing on both recent and cumulative exposure to inhaled corticosteroids (ICS) and systemic corticosteroids within 1 year before the occurrence of fractures.

Results: From an initial cohort of 30,409 children, 13,275 were included in the final analysis, comprising 2325 asthma patients and 10,950 non-asthma controls. Asthma was associated with a higher risk of fractures (Odds Ratio [OR]: 1.22, 95% CI: 1.12-1.34, p < .001). Among asthma patients, recent ICS use within 90 days before a fracture was linked to the highest risk (Adjusted Odds Ratio [Adjusted OR]: 2.98, 95% CI: 2.95-3.05, p < .001). Systemic corticosteroid use showed a dose-dependent relationship with increased fracture risk.

Conclusion: Pediatric asthma and corticosteroid treatment are both significantly associated with elevated fracture risk. These results emphasize the necessity for comprehensive asthma management strategies that prioritize bone health.