Do short courses of oral corticosteroids and use of inhaled corticosteroids affect bone health in children?

This Practice Point commentary discusses the findings of a prospective study by Kelly et al. that evaluated the effect of multiple short courses of oral corticosteroids and use of inhaled corticosteroids on bone accrual in children with asthma. The researchers determined the cumulative number of short courses of oral corticosteroids and the cumulative dose of inhaled corticosteroids over a 7-year study period. Multiple short courses of oral corticosteroids in boys, but not girls, were a dose-dependent risk factor for decreased bone-mineral accrual and osteopenia. Inhaled corticosteroid use in boys, but not girls, was also associated with decreased bone accrual, but the association was not dose-dependent. However, no effect of corticosteroids on fracture risk was found. Here, I discuss the relevance of these findings in relation to attainment of peak bone mass and outline how the findings could be complicated by disease-related effects of asthma on bone health.