Corticosteroids for Asthma Could Increase Fracture Risk

Sarfaroj Khan 


October 27, 2020


  • Exposure to oral corticosteroid (OCS) and inhaled corticosteroid (ICS) is an independent risk factor for bone health in patients with asthma.

  • A clear dose-response relationship is seen between cumulative dose and prescriptions of OCS/ICS and risk of osteoporosis and fragility fractures (FF).

Why this matters

  • Findings provide guidance to physicians by stratifying bone health risk by dose, number of prescriptions and type of OCS and ICS.

Study design

  • 2 population-based nested case-control studies used data from the UK Clinical Practice Research Datalink and Hospital Episode Statistics databases.

  • 1564 patients with asthma and osteoporosis (3313 control participants) and 2131 with asthma and FF (4421 control participants) were included.

  • Association between ICS and OCS exposure and the risk of osteoporosis or FF was evaluated.

  • Funding: British Medical Association.

Key results

  • OCS:

    • Patients receiving more prescriptions (≥9 vs 0) were at a greater risk of osteoporosis (adjusted OR [aOR], 4.50; 95% CI, 3.21-6.11) and FF (aOR, 2.16; 95% CI, 1.56-3.32)

    • Similarly, those receiving more cumulative doses (≥2500 mg vs 0 mg) were at a greater risk of osteoporosis (aOR, 4.79; 95% CI, 3.38-6.79) and FF (aOR, 1.99; 95% CI, 1.30-3.04).

  • ICS:

    • Patients receiving more prescriptions (≥11 vs 0) were at an increased risk of osteoporosis (aOR, 1.60; 95% CI, 1.22-2.10) and FF (aOR, 1.31; 95% CI, 1.02-1.68).

    • Similarly, those exposed to more cumulative doses (>120 mg vs 0 mg) were at a greater risk of osteoporosis (aOR, 1.63; 95% CI, 1.33-1.99) and FF (aOR, 1.20; 95% CI, 1.08-1.42).

  • The prevalence of patients taking ≥9 OCS and ≥1 bisphosphonate prescription was just 50.6% and 48.4% for osteoporosis and FF, respectively.


  • Risk of diagnostic misclassification.


Chalitsios CV, Shaw DE, McKeever TM. Risk of osteoporosis and fragility fractures in asthma due to oral and inhaled corticosteroids: two population-based nested case-control studies. Thorax. 2020 Oct 21 [Epub ahead of print]. doi: 10.1136/thoraxjnl-2020-215664. PMID: 33087546 View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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