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Epidural Steroid Injection and Bone Loss


Painkillers and Loss of Bone Mass

As if postmenopausal women did not have enough to worry concerning bone loss, new research says epidural steroids for back pain robs them of bone.

“A single epidural steroid injection in postmenopausal women adversely affects bone mineral density of the hip…Our findings show that epidural administration of corticosteroids has a deleterious effect on bone, which should be considered when contemplating treatment options for radiculopathy. The resulting decrease in bone mineral density, while slight, suggests that epidural steroid injections should be used with caution in those at a risk for fracture.”1

Other researchers, however, disagree. While they agree that corticosteroids often results in bone loss and corticosteroid-induced osteoporosis, they say it has nothing to do with bone mineral density because no link has been made between epidural steroid injection and bone mineral density. Further smaller doses are okay. Here’s what they say:

“These data suggest that epidural steroid injection using triamcinolone (over 200 mg) for a period of one year will have a negative effect on bone mineral density in postmenopausal women treated for lower back pain. However, ESI therapy using a maximum cumulative triamcinolone dose of 200 mg in one year would be a safe treatment method with no significant impact on BMD.”

[Fortunately these researchers recognized their limitations]: First, this study is limited by the fact that it was retrospective. Second, our study did not consider the use of ESI with high-dose corticosteroids. Third, our study did not include any long-term assessments of the effects of ESI on BMD.” 2

So the findings do not include long-term high dose steroid use. Wow. After further review a similar group of researchers came back and said. “Therapy with glucocorticoids often results in bone loss and glucocorticoid-induced osteoporosis. However, the relationship between epidural steroid injection (ESI), bone mineral density (BMD), and vertebral fracture remains to be determined.” Confused? Read the research, it wasn’t the steroids – it was old age:

“Older age and lower bone mineral density were associated with osteoporotic fracture in postmenopausal women treated for low back pain with epidural steroid injection. The epidural steroid injections were not associated with low bone mineral density or fracture.”

Again, the limitations were that this research was not valid for patients who received high-dose corticosteroids, that study group was very small to provide assessment.3

This article presents significant updates in the research to our October 1, 2012 article on the dangers of epidural steroid injections in pre- and post menopausal women. We have also discussed these dangers in an article comparing low back pain injection treatments.

For more on Prolotherapy as a safe and effective alternative to epidural steroid injections for pain, contact us here or follow us on Facebook.
1. Al-Shoha A, Rao D, Schilling J, Peterson E, Mandel S. Effect of Epidural Steroid Injection on Bone Mineral Density and Markers of Bone Turnover in Postmenopausal Women. Spine. 37(25):E1567-E1571, December 01, 2012.

2. Kang SS, Hwang BM, Son H, Cheong IY, Lee SJ, Chung TY.Changes in bone mineral density in postmenopausal women treated with epidural steroid injections for lower back pain. Pain Physician. 2012 May-Jun;15(3):229-36.

3. Yi Y, Hwang BM, Son H, Cheong IY. Low bone mineral density, but not epidural steroid injection, is associated with fracture in postmenopausal women with low back pain. Pain Physician. 2012 Nov;15(6):441-9.

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