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Are boys with asthma more susceptible to bone fractures?
New Australian research shows that asthma may be associated with an increased possibility of childhood bone fractures, especially for boys. By Lim Wan Er

Not to be taken lightly

As one of the most common noncommunicable diseases worldwide, asthma needs no further introduction although most are not fully aware of the underlying risks. There is no cure for asthma. Even if you feel well enough to be out and about, you still have the disease and it can be triggered by many factors.

In 2017, the World Health Organisation estimated 235 million people currently suffer from asthma,5 and the prevalence of childhood asthma is progressively increasing over the decades in Asia and other continents as well. Some may take this topic lightly as asthma has a comparatively low fatality rate compared to other chronic diseases. Nonetheless, asthma is still a dangerous disease that proves to be fatal if left untreated or poorly controlled. Imagine multiple visits to the emergency room and hospitalisation, not to mention the constant coughing, wheezing and shortness of breath. The bad news is that the only treatment available is to keep it under control with good care, although it is relatively easy due to technology advancements today.

People of all ages are at risk of asthma, but it often starts during childhood. There are some estimated one-in-seven children found with asthma.1 Young children are at highest risk of developing asthma which extends beyond six years of age, mainly those who often have respiratory problems. It is also worth noting that among children, there are more cases of asthma found in boys as compared to girls.6 This brings us to the topic – the association between asthma and bone fractures, and why boys with moderately severe asthma are 30 per cent more likely to fracture a bone as compared to their peers without the disease.5

Higher risk of bone fractures

A large Australian study was conducted, involving more than 16,000 primary school students between ages three to 14, to investigate the association between asthma and bone fractures. The study was published in the Journal of Paediatrics and Child Health, led by researcher Dr Sharon Brennan-Olsen at the University of Melbourne.1 She stated that “What we found was that the severity of asthma was associated with radiologically confirmed fracture in children – more likely boys than girls”.2

One reason is that boys are generally more active than girls, which increases their chances of getting hurt while having fun. It has been found that boys with asthma are 30 per cent more likely to have a fracture as compared to girls with asthma not only due to their different lifestyle behaviours, but also due to later puberty stages in boys. We believe that boys are more likely to take part in rough activities such as rugby or soccer, while girls are inclined to veer towards slower activities such as yoga or swimming. Yet, the more important reason is due to faster maturing bodies and bone development in girls.

Dr Brennan-Olsen noted that “Boys’ bones are less developed than girls...girls have the greatest bone mass accrual when aged 11-15 years, whilst for boys that bone mass is accrued later (14-15 years)”.3 She also added that bone development for children stops at approximately age 20, which illustrates that bone development is less mature in boys because they are maturing later. Therefore, it is generally easier for boys to obtain bone fractures. She explained that “increased fracture rates actually relate to the bone mineralisation lagging in bone growth”.2 However, it has been found that in both genders, asthma generally increases the link of fracture due to the inflammatory nature of asthma that impede with bone formation and resorption.3

Tips for parents

Unfortunately, there is a limit to what you can do as a parent except to be aware of the increased risk of fracture, especially for boys with asthma. The research findings highlight the lack of bone health education and the need to promote bone health for both parents and children alike. Dr Brennan-Olsen mentioned, “What we do in early childhood determines what could happen in later life, and whether those children develop musculoskeletal problems”.3

If you have a child diagnosed with asthma, you should be familiar with inhaled corticosteroids - also known as the medicine found in an asthma inhaler. The drug works by reducing inflammation, mucus production and swelling in the airways, allowing the asthma to be kept under control. Past research has also visited the concern that inhaled corticosteroids may have adverse effects on bone mineral density in children. It has since been found in this study that the increase in bone fracture is not related to the drugs found in asthma reliever puffers or inhalers.2 Thus, it is important that medication still be taken, be it preventers or relievers.

A misconception is that people with asthma should abstain from exercise as it causes an increased breathing rate and may trigger an asthma attack. Due to these adverse effects, children with asthma are always asked to sit out of physical education classes in school and are not encouraged to participate in vigorous activities. Research now suggests that well-tolerated cardio activities are very highly recommended. One example would be swimming in indoor swimming pools, where the high humidity protects against asthma attacks by keeping airways open. Paediatric pulmonologist, Dr Tod Olin stated that if the airways do not dry out, the asthma attack can be prevented all together. It can also be a dilemma for parents to allow their child with asthma to take on sports as “all it takes is one asthma attack, and suddenly patients can become very tentative about overdoing it”, he added.

You should be concerned about your existing asthma condition if:6

  • Your symptoms occur more often, more severe and causes insomnia
  • Your daily activities are limited
  • Your peak flow is low as compared to normal days
  • Your medicines do not work as efficiently
  • You reach for your inhaler more often
  • You must visit the doctor because of an asthma attack
  1. https://www.theaustralian.com.au/news/latest-news/boys-with-asthma-at-risk-of-bone-fractures/news-story/8ff36278f9a674d0910bfc1c0811774c
  2. http://www.abc.net.au/news/2018-04-04/asthma-linked-to-bone-fractures-in-children-study-reveals/9619290
  3. https://pursuit.unimelb.edu.au/articles/boys-with-asthma-risk-more-broken-bones
  4. https://www.health24.com/Medical/Asthma/Asthma-and-exercise/heres-why-swimming-is-good-for-asthmatic-kids-20170221
  5. http://www.who.int/mediacentre/factsheets/fs307/en/
  6. https://www.nhlbi.nih.gov/health-topics/asthma
Always game for a good cup of iced latte and soggy fries, Lim Wan Er indulges in a solo vacation at least once a year for the sole purpose of exploring the local cuisine.

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