Long-term fracture risk among children with asthma: A population-based study

L. Joseph Melton, Ashok Patel, Sara J. Achenbach, Ann L Oberg, John W. Yunginger

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Fracture risk among patients diagnosed with asthma in childhood is greater in males and oral corticosteroid users, but most fractures are of the appendicular skeleton and may relate to impaired skeletal development. Introduction: There are no population-based data on fracture outcomes among the growing number of patients with asthma diagnosed in childhood. Materials and Methods: We conducted a population-based retrospective (historical) cohort study among 279 Rochester, Minnesota, residents who were <35 years of age (mean, 6.2 years) when first diagnosed with asthma. Fractures were ascertained by review of comprehensive community medical records, and cases were compared directly with age- and sex-matched controls in a stratified proportional hazards model. Risk factors for fractures among the asthma cases were assessed using Andersen-Gill time-to-fracture regression models. Results: During 6649 person-years of follow-up (median, 24.3 years/subject), 107 asthma patients experienced 189 fractures, for a crude fracture incidence rate of 2.8 per 100 person-years. The actuarially estimated cumulative fracture incidence after 20 years was 40% compared with 34% among controls (p = 0.122). There was no significant increase in overall fracture risk among cases compared to their age- and sex-matched controls (hazard ratio [HR], 1.3; 95% CI, 0.9-1.9), but males with asthma had a 2.6-fold greater risk of hand and finger fractures than control males. The independent predictors of overall fracture risk among the asthma patients included male gender (HR, 2.2; 95% CI, 1.5-3.2) and use of oral corticosteroids (HR, 2.0; 95% CI, 1.2-3.1) or anti-cholinergic agents (HR, 3.9; 95% CI, 1.5-10). Conclusions: Rather than osteoporotic fractures of the axial skeleton, oral corticosteroid therapy was associated here with limb fractures, suggesting a relationship with impaired development of a biomechanically competent skeleton. Additional studies are needed to assess this possibility.

Original languageEnglish (US)
Pages (from-to)564-570
Number of pages7
JournalJournal of Bone and Mineral Research
Volume20
Issue number4
DOIs
StatePublished - Apr 2005

Fingerprint

Asthma
Population
Skeleton
Adrenal Cortex Hormones
Safety Management
Osteoporotic Fractures
Incidence
Cholinergic Antagonists
Proportional Hazards Models
Cholinergic Agents
Fingers
Medical Records
Cohort Studies
Extremities
Hand

Keywords

  • Asthma
  • Epidemiology
  • Fracture
  • Osteoporosis
  • Pediatrics

ASJC Scopus subject areas

  • Surgery

Cite this

Long-term fracture risk among children with asthma : A population-based study. / Melton, L. Joseph; Patel, Ashok; Achenbach, Sara J.; Oberg, Ann L; Yunginger, John W.

In: Journal of Bone and Mineral Research, Vol. 20, No. 4, 04.2005, p. 564-570.

Research output: Contribution to journalArticle

Melton, L. Joseph ; Patel, Ashok ; Achenbach, Sara J. ; Oberg, Ann L ; Yunginger, John W. / Long-term fracture risk among children with asthma : A population-based study. In: Journal of Bone and Mineral Research. 2005 ; Vol. 20, No. 4. pp. 564-570.
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AB - Fracture risk among patients diagnosed with asthma in childhood is greater in males and oral corticosteroid users, but most fractures are of the appendicular skeleton and may relate to impaired skeletal development. Introduction: There are no population-based data on fracture outcomes among the growing number of patients with asthma diagnosed in childhood. Materials and Methods: We conducted a population-based retrospective (historical) cohort study among 279 Rochester, Minnesota, residents who were <35 years of age (mean, 6.2 years) when first diagnosed with asthma. Fractures were ascertained by review of comprehensive community medical records, and cases were compared directly with age- and sex-matched controls in a stratified proportional hazards model. Risk factors for fractures among the asthma cases were assessed using Andersen-Gill time-to-fracture regression models. Results: During 6649 person-years of follow-up (median, 24.3 years/subject), 107 asthma patients experienced 189 fractures, for a crude fracture incidence rate of 2.8 per 100 person-years. The actuarially estimated cumulative fracture incidence after 20 years was 40% compared with 34% among controls (p = 0.122). There was no significant increase in overall fracture risk among cases compared to their age- and sex-matched controls (hazard ratio [HR], 1.3; 95% CI, 0.9-1.9), but males with asthma had a 2.6-fold greater risk of hand and finger fractures than control males. The independent predictors of overall fracture risk among the asthma patients included male gender (HR, 2.2; 95% CI, 1.5-3.2) and use of oral corticosteroids (HR, 2.0; 95% CI, 1.2-3.1) or anti-cholinergic agents (HR, 3.9; 95% CI, 1.5-10). Conclusions: Rather than osteoporotic fractures of the axial skeleton, oral corticosteroid therapy was associated here with limb fractures, suggesting a relationship with impaired development of a biomechanically competent skeleton. Additional studies are needed to assess this possibility.

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