CHILDREN with asthma face a heightened risk of fractures, particularly when treated with corticosteroids, according to findings from a large nationwide cohort study. The research highlights the importance of integrating bone health considerations into pediatric asthma management.
Using data from South Korea’s National Health Insurance Service, investigators analyzed records of 13,275 children born between 2002 and 2004, including 2,325 with asthma and 10,950 matched controls. Exclusion criteria removed children with preexisting fractures, severe comorbidities, or asthma diagnoses before age six. Logistic regression models adjusted for demographic and clinical factors were applied to examine fracture risk.
The study revealed that asthma itself was linked to a significantly greater risk of fractures, with an odds ratio of 1.22 (95% CI: 1.12–1.34, p<0.001) compared with non-asthmatic peers. The association was particularly pronounced among children exposed to corticosteroids. Recent use of inhaled corticosteroids within 90 days of a fracture carried the greatest risk, with an adjusted odds ratio of 2.98 (95% CI: 2.95–3.05, p<0.001). Furthermore, systemic corticosteroid therapy demonstrated a clear dose-dependent relationship with fracture incidence.
The findings suggest that both the disease process of asthma and the pharmacological interventions commonly used to control it contribute to increased bone fragility in children. The authors emphasize that asthma care must extend beyond airway control to include strategies for preserving musculoskeletal health.
This study underscores the need for vigilance among clinicians prescribing corticosteroids in pediatric populations, particularly for long-term or high-dose use. Monitoring bone health and incorporating preventive measures may help reduce fracture risk while maintaining effective asthma control.
Reference: Ji H et al. Association between corticosteroid use and fracture risk in children with asthma: A nationwide cohort study. Pediatr Allergy Immunol. 2025. doi:10.1111/pai.70143
