Epidural Steroids Associated With Decreased Bone Density

Epidural Steroid Injections Associated With Decreased Bone Mineral Density, Increased Risk for Vertebral Fracture – Jessica Martin – January 25, 2018

Another reason to avoid epidural injections for pain:

In this systematic review and critical literature appraisal, researchers evaluated 8 studies (n=7233) that reported on the effects of epidural steroid injections on bone mineral density, osteoporosis, vertebral fracture, or osteopenia.

Across all studies, mean changes in bone mineral density ranged from 0.06% to 1.25% in the lumbar spine and from −2.87% to 0.45% in the femoral neck.  

Though they can be helpful for some people sometimes, I’ve posted several times about the high danger for patients (and the high profit for doctors that perform them).

Of the 8 studies evaluated,

• 5 focused on postmenopausal women only, and
• 3 included men and women of any age.
• The follow-up ranged from 6 to 60 months, and
• the steroids used included triamcinolone, dexamethasone, methyl-prednisolone, and betamethasone,
• with doses ranging from 10 to 120 mg.
• The mean number of injections across all studies was 14.7.
• The mean cumulative injection dose in methyl-prednisolone equivalents ranged from 80 to 8130 mg.

Among patients who received epidural steroid injections, low bone mineral density was reported by 52.5% to 96.2% of patients in the lumbar spine and by 29% to 93.5% of patients in the femoral neck.

In postmenopausal women, cumulative doses of triamcinolone >200 mg during a 1-year period or >400 mg during a 3-year period were associated with reduced bone mineral density.

In 1 study, each additional epidural steroid injection was shown to increase the risk for fracture (relative risk, 1.21; 95% CI, 1.08-1.30).

The study authors concluded that:

“[Epidural steroid injections] seem to decrease [bone mineral density], both locally (lumbar spine) and systemically (femoral neck) in doses as low as 80 mg of [methyl-prednisolone] equivalents and to increase the risk of vertebral fracture.”

For anyone contemplating this treatment, I strongly recommend 

Hidden Danger of Intraspinal Steroid Injections

For more scientific studies, see Spinal injections: comprehensive review of the literature.

Also:

• Untrained pain docs performing epidural steroid injections
• Potential Complications Of Epidural Steroid Injections
• FDA warns about Steroid Injections
• The Safety of Epidurals: What You Need to Know

 

Looking through my blog using the tag “epidural-injection“, I notice the same was found in elderly patients 5 years ago. From Dec 2013: Epidural Steroid Injections May Increase Risk for Vertebral Body Fractures.

This study dealt with elderly patients and clearly demonstrates that one should talk to elderly patients about the risks of steroid injection, including fragility fracture.