Importance 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. Objective To determine whether there is an increased risk of bone fracture associated with inhaled corticosteroid use in children with asthma. Design, Setting, and Participants In this population-based nested case-control study, we used health administrative databases to identify a cohort of children aged 2 to 18 years with a physician diagnosis of asthma between April 1, 2003, and March 31, 2014, who were eligible for public drug coverage through the Ontario Drug Benefit Program (Ontario, Canada). We matched cases of first fracture after asthma diagnosis to fracture-free controls (ratio of 1 to 4) based on date of birth (within 1 year), sex, and age at asthma diagnosis (within 2 years). We used a 1-year lookback period to ascertain history of inhaled corticosteroid use. Multivariable conditional logistic regression was used to obtain an odds ratio (OR) with 95% confidence interval for fracture, comparing no inhaled corticosteroid use vs current, recent, and past use. Exposures Inhaled corticosteroid use during the child’s 1-year lookback period, measured as current user if the prescription was filled less than 90 days prior to the index date, recent user (91-180 days), past user (181-365 days), or no use. Main Outcomes and Measures First emergency department visit for fracture after asthma diagnosis, identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes. Results This study included 19 420 children (61.0% male; largest proportion of children, 31.5%, were aged 6-9 years at their index date). The multivariable regression results did not show a significant association between first fracture after asthma diagnosis and current use (OR, 1.07; 95% CI, 0.97-1.17), recent use (OR, 0.96; 95% CI, 0.86-1.07), or past use (OR, 1.00; 95% CI, 0.91-1.11) of inhaled corticosteroids, compared with no use, while adjusting for sociodemographic factors and other medication use. However, use of systemic corticosteroids in the 1-year lookback period resulted in greater odds of fracture (OR, 1.17; 95% CI, 1.04-1.33). Conclusions and Relevance Systemic corticosteroids, but not inhaled corticosteroids, were significantly associated with increased odds of fracture in the pediatric asthma population.

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哮喘儿童吸入性皮质类固醇的使用与骨折的关系

重要性 每天使用吸入性皮质类固醇是治疗儿童轻度持续性哮喘的广泛推荐的治疗方法。有人担心，与全身性皮质类固醇类似，吸入性皮质类固醇可能对骨骼健康产生不利影响。目的 确定哮喘儿童吸入皮质类固醇是否会增加骨折风险。设计、设置和参与者 在这项基于人群的巢式病例对照研究中，我们使用卫生行政数据库确定了 2003 年 4 月 1 日至 2014 年 3 月 31 日期间医生诊断为哮喘的 2 至 18 岁儿童队列，他们有资格通过安大略药物福利计划（加拿大安大略省）获得公共药物保险。我们根据出生日期（1 年内）、性别和哮喘诊断时的年龄（2 年内）将哮喘诊断后首次骨折的病例与无骨折的对照组（比例为 1 比 4）进行匹配。我们使用了 1 年的回顾期来确定吸入性皮质类固醇的使用史。多变量条件逻辑回归用于获得具有 95% 置信区间的骨折比值比 (OR)，比较未使用吸入性皮质类固醇与当前、最近和过去使用的情况。暴露 儿童 1 年回顾期内吸入的皮质类固醇使用情况，如果在索引日期前不到 90 天开处方，则作为当前用户测量，最近用户（91-180 天），过去用户（181-365 天），或没有用。主要结果和措施 哮喘诊断后首次急诊就诊骨折，使用国际疾病和相关健康问题统计分类，第 10 次修订版代码确定。结果 本研究包括 19 420 名儿童（61.0% 为男性；最大比例的儿童，31.5%，在其索引日期为 6-9 岁）。多变量回归结果未显示哮喘诊断后首次骨折与当前使用 (OR, 1.07; 95% CI, 0.97-1.17)、近期使用 (OR, 0.96; 95% CI, 0.86-1.07) 或过去使用（OR，1.00；95% CI，0.91-1.11）吸入性皮质类固醇与未使用相比，同时调整社会人口因素和其他药物使用。然而，在 1 年回顾期内使用全身性皮质类固醇导致骨折的可能性更大（OR，1.17；95% CI，1.04-1.33）。结论和相关性全身性皮质类固醇，但不是吸入性皮质类固醇，