Children with atopic dermatitis were shown to be at an increased risk of fractures compared with the general population, with systemic use of corticosteroid and antihistamine therapy cited as mediating factors.
Common in children and the elderly, fractures have been cited as risk factors for patients with inadequately controlled AD due to the impaired bone health associated with these populations. Moreover, studies of adults with AD have indicated that the increased risk for fracture in those with inadequately controlled disease is linked to the use of systemic corticosteroids and their consequent impact on bone mineral density, noted the researchers.
With the relationship between childhood AD and risk fractures remaining uncertain, the researchers conducted a retrospective cohort study of children with and without AD from a longitudinal matched cohort database of 353,040 children enrolled in the national health insurance service and national health-screening program of Korea.
Risk of accidental fracture events over a follow-up of 8.9 years was compared between children with AD (n = 29,162) and those without (n = 116,542) in the propensity score-matched cohort. Separate subgroup analyses stratified risk of fracture in 4 regions of the body: skull and facial bones, trunk including vertebrae, proximal limbs, and distal limbs.
“The mediating effects of 10 possible clinical factors (including use of antihistamines and systemic corticosteroids) and social factors (including nutritional status and parental safety awareness) were determined,” the study authors added.
Over the follow-up period, the prevalence of fracture events was 21.2% (95% CI, 21.0%-21.4%; mean [SD] age, 65.0 [28.9] months) in children without AD and 22.8% (95% CI, 22.3%-23.3%; mean age, 64.6 [29.2] months) in children with AD.
Compared with those without AD, children with AD exhibited an 8% increased risk of fracture events overall (adjusted relative risk [aRR], 1.08; 95% CI, 1.05-1.10), with subgroup analyses showing consistently significant associations of AD and fracture, except for the proximal bones:
Notably, use of a systemic corticosteroid prescription was indicated as the largest mediating factor regarding risk of fractures in children with AD (adjusted least-squares mean [ALM], 61.7%; 95% CI, 60.9%-62.5%), followed by duration of antihistamine prescription (ALM, 57.3%; 95% CI, 56.5%-58.1%) and infant feeding practices (ALM, 49.7%; 95% CI, 49.1%-50.3%).
In particular, the researchers noted that the duration of systemic corticosteroid prescription was significantly associated with fracture events (incidence: 20.1% at the 25th percentile and 23.6% at the 75th percentile.
“Altogether, our findings suggest that physicians should be aware in using medications and assessing the prognosis for patients with AD, who are at higher risks of childhood bone injury which might be more easily resulting in fracture,” they said.
Ha EK, Kim JH, Kwak JH, et al. Association of clinical and social factors with risk of fracture in children with atopic dermatitis. Pediatr Allergy Immunol. Published online December 4, 2021. doi:10.1111/pai.13712