Steroid use may be linked to risk for some musculoskeletal diseases

The investigators found no association between steroid use and an increased risk of tendon injuries.

A survey of more than 3,000 retired National Football League players links anabolic-androgenic steroid use to an increased risk for specific musculoskeletal diseases.

“Our findings speak to the compounded medical problems that appear with steroid use, with negative effects on joint health starting a ‘snowball effect’ that can lead to other chronic diseases later in life,” senior author Kevin Guskiewicz, PhD, ATC, professor of exercise and sport science and research director at The Center for the Study of Retired Athletes at the University of North Carolina (UNC) at Chapel Hill, said in a press release.

The study was lead by Scott Horn, DO, of the department of physical medicine and rehabilitation in the UNC School of Medicine, and appears in the March issue of the American Journal of Physical Medicine & Rehabilitation.

Survey of NFL players

Horn and his colleagues sent surveys to 3,683 members of the National Football League (NFL) Retired Players Association requesting information about health issues, including the types of musculoskeletal injuries the retired players sustained during their NFL careers. The survey also included a question on performance-enhancing steroid use.

The investigators received responses from 2,552 players. The respondents had an average age of 54 years and an average NFL career of 6.6 years, according to a press release of the study.

The researchers reported that 9.1% of respondents said they had used anabolic-androgenic steroids. They also found that players who used steroids reported more cartilage and joint ligament injuries. Likewise, players who used steroids reported higher rates of herniated discs and injuries to the neck, elbow, knee ligaments and menisci, and the ankle, foot and toes.

However, the investigators found no steroid-related increases in the risk of shoulder and muscle injuries. They also discovered no link between steroid use and increased risk of tendon injuries.

The study also revealed that players who used steroids had a higher risk for depression, osteoarthritis and increased alcohol use later in life, according to the release.

Snowball effect

In addition to suggesting that the ligaments and cartilage — not the tendons — are the “weakest link in the chain” leading to steroid-associated injuries, the investigators noted that the impact of steroids on the joints may lead to a cascade of other health effects.

“I call it a snowball effect, with joint injuries contributing to the gradual development of other medical problems such as osteoarthritis, physical inactivity, depression, obesity and diabetes,” Guskiewicz said in the release.

The investigators cited a lack of information regarding the type and dose of steroids taken and the length of steroid use among their study limitations.

Freddie H. Fu, MD, a member of the Orthopedics Today and Orthopaedics Today Europe editorial boards, questioned the survey’s accuracy and design. He also noted that the respondents may not have understood the survey and that there did not seem to be a physical examination of the patients’ injuries.

“Did they do a test market first?” Fu asked. “Did they do it in 50 people first and see how they respond and then do some analysis? I do not know. I am always skeptical about a survey. That is the only question that I have.”

For more information:
Freddie H. Fu, MD, can be reached at the University of Pittsburgh, Department of Orthopedic Surgery, 3471 Fifth Ave., Suite 1011, Pittsburgh, PA 15213; (412) 687-3900; e-mail: ffu@upmc.edu.

Reference:
Horn S. Gregory P, Guskiewicz KM. Self-reported anabolic-androgenic steroids use and musculoskeletal injuries: Findings from the Center for the Study of Retired Athletes health survey of retired NFL players. Am J Phys Med & Rehab. 88(3):192-200.