Inhaled Corticosteroids and Bone Mineral Density at School Age: A Follow-up Study After Early Childhood Wheezing

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The aim of the study was to evaluate the association between previous use of ICS and bone mineral density (BMD) at school age in a cohort followed after early childhood wheezing.


As part of a prospective follow-up study after hospitalization for wheezing at <24 months of age, BMD was measured in 89 children at 12.3 (median) years of age. Data on ICS use were collected by interviewing the parents, and this was supplemented with data from patient records. Cumulative doses and the duration of ICS use were calculated. Areal BMD (BMDareal, g/cm2) was measured by dual energy X-ray absorptiometry (DXA), and apparent volumetric BMD (aBMDvol, g/cm3) was calculated, for the lumbar spine and femoral neck. Weight, height and pubertal stage were recorded.


Age, sex, and pubertal stage were significantly associated with BMDareal and aBMDvol of the lumbar spine and BMDareal of the femoral neck. The regular use of ICS for >6 months at age <6 years was associated with a lower BMD of the lumbar spine. A lower BMDareal and aBMDvol of the femoral neck were associated with higher cumulative doses of ICS at age 0–12.3 (median) years. The results were robust to adjustment for age, sex, pubertal stage, height, weight, and use of systemic steroids.


ICS use during childhood may be related to a decrease in BMD at late school age. It is important to use the lowest possible ICS dose that maintains adequate asthma control. Pediatr Pulmonol. 2015; 50:1–7. © 2013 Wiley Periodicals, Inc.

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