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Injectable steroid for back pain led to BMD loss in postmenopausal women
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Previous studies have established that one of the major adverse effects of steroid use is glucocorticoid-induced osteoporosis. In a recent study published in Spine, researchers have suggested that postmenopausal women who were administered a single epidural steroid injection as treatment for back pain adversely experienced significant BMD loss of the hip.
“The findings of our study suggest that epidural steroid injections (ESI) for back pain relief should be approached cautiously in patients at risk for bone fragility,” co-author of the study and orthopedic physician at Henry Ford Health System, Shlomo Mandel, MD, said in a press release. “Physicians who do prescribe them should consider measures that optimize bone health such as calcium and vitamin D supplements and exercise as part of their patient’s treatment plan.”
Shlomo Mandel
In the prospective, observational study, Mandel and colleagues examined white women (n=28) who were at least 10 years postmenopausal with nerve root compression at the L4-L5 level.
Kenalog-80 (80 mg/mL of triamcinolone acetonide injectable suspension; Bristol-Myers Squibb) was administered at the L4-L5 level. Patients underwent baseline BMD of the total hip, femoral neck and spine using dual-energy X-ray absorptiometry (DEXA); and a measurement of 2 serum biochemical markers of bone turnover (C-terminal telopeptide of type 1 collagen; CTX). They also underwent bone-specific alkaline phosphatase (BSAP) for bone formation measurement.
According to data, the mean BMD of the hip before ESI was 0.979g/cm2. Six months after the injection, the mean BMD of the hip measured 0.961g/cm2, the researchers wrote. Moreover, the decline of 0.018g/cm2 in the total hip BMD from baseline to 6 months following injection was significant (P=.002).
“Therefore, our finding of a 0.018g/cm2 during a 6-month period after ESI suggests a 6-fold increase in the average yearly rate of bone loss in the hip,” the researchers wrote.
They suggest careful approaches to lumbar radiculopathy in patients at risk for bone loss and further studies with a longer follow-up period.
Disclosure: One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies.
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