352 The Effect of Epidural Steroid Injections on Bone Mineral Density and Vertebral Fracture Risk: A Systematic Review and Critical Appraisal of Current Literature

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 280-280
Author(s):  
Panagiotis Kerezoudis ◽  
Lorenzo Rinaldo ◽  
Mohammed Ali Alvi ◽  
Sandy Goncalves ◽  
Christine Hunt ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Femoral Neck ◽  
Osteoporotic Fractures ◽  
Mineral Density ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Vertebral Fracture Risk ◽  
Patients At Risk ◽  
One Year ◽  
Epidural Steroid

Abstract INTRODUCTION Epidural steroid injections (ESIs) are a common treatment for the management of patients with radicular back pain. It is also known that the long-term enteral administration of exogenous steroids disrupts bone health and skeletal micro-architecture METHODS A systematic and critical review of recent literature was conducted in accordance with PRISMA guidelines. RESULTS >A total of 8 studies were included in the analysis (6 retrospective, 2 prospective). A total of 7233 patients with a mean age ranging between 49 and 74 years and an average follow-up between 6 and 60 months were studied. Steroids that were used included triamcinolone, dexamethasone, and methylprednisolone (MP), with a mean number of injections ranging from 1 to 14.7 and average cumulative dose in MP equivalents between 80 and 8130 mg. A single ESI was shown to decrease BMD as measured at the femoral neck by 1.8%, and increase the risk of vertebral fracture by 21%. Significant reductions in BMD were associated with a cumulative MP dose of 200 mg over a one year period and 400 mg over three years, but not in doses of less than 200 mg of MP equivalents for postmenopausal women and at least 3 g for healthy men. The risk of osteopenia and osteoporosis was lower in patients that were receiving anti-osteoporotic medication during the treatment course. CONCLUSION ESIs can decrease BMD, both locally (lumbar spine) and systemically (femoral neck) and increase the risk of vertebral fracture. Therefore, ESIs should be recommended with caution, especially in patients at risk for osteoporotic fractures, such as women of postmenopausal age. Anti-osteoporotic medication might be considered prior to ESI.

scholarly journals The Effect of Epidural Steroid Injections on Bone Mineral Density and Vertebral Fracture Risk: A Systematic Review and Critical Appraisal of Current Literature

Pain Medicine ◽  
2018 ◽  
Vol 19 (3) ◽  
pp. 569-579 ◽  
Author(s):  
Panagiotis Kerezoudis ◽  
Lorenzo Rinaldo ◽  
Mohammed Ali Alvi ◽  
Christine L Hunt ◽  
Wenchun Qu ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Systematic Review ◽  
Vertebral Fracture ◽  
Fracture Risk ◽  
Critical Appraisal ◽  
Mineral Density ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Vertebral Fracture Risk ◽  
Epidural Steroid

scholarly journals Effect of Lumbar Epidural Steroid Injections on Osteoporotic Fracture and Bone Mineral Density in Elderly Women with Diabetes Mellitus

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Minsoo Kim ◽  
Jiwon Bak ◽  
Sejin Kim ◽  
Hee-Jeong Son ◽  
Seong-Sik Kang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Bone Mineral Density ◽  
Bone Mineral ◽  
Elderly Women ◽  
Osteoporotic Fractures ◽  
Mineral Density ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
The Mean ◽  
Epidural Steroid

The incidence of osteoporosis and diabetes mellitus (DM) is known to increase with aging. DM is associated with osteoporotic fractures and decreased bone mineral metabolism. However, no studies have compared the effects of DM on the changes in bone mineral density (BMD) and osteoporotic fracture after epidural steroid injections (ESIs). The present study aimed to analyze the relationship between ESI and BMD changes in elderly women with and without DM. The medical records of elderly women who underwent ESI were retrospectively analyzed. All patients had radiographic and BMD assessments performed before and after receiving lumbar ESIs. A total of 172 patients were divided into two groups according to the presence of DM. The duration of BMD monitoring was 16.1 and 16.8 months in the non-DM and DM groups, respectively. The mean total number of ESIs was 3.4 and 3.2, and the mean cumulative administered dose of glucocorticoids (dexamethasone) was 17 and 16 mg in the non-DM and DM groups, respectively. There were no significant differences between baseline and posttreatment BMD in the lumbar spine, total femur, and femoral neck region in either group. The incidence of osteoporotic fractures at the hip joint and thoracolumbar spine was not significantly different in both groups. ESIs could be used without concerns regarding osteoporosis and fractures in elderly women with DM if low doses of glucocorticoids are used.

Repeat epidural steroid injections for radicular pain due to lumbar or cervical disc herniation

2018 ◽  
Vol 100-B (10) ◽  
pp. 1364-1371 ◽  
Author(s):  
H. Joswig ◽  
A. Neff ◽  
C. Ruppert ◽  
G. Hildebrandt ◽  
M. N. Stienen
Keyword(s):  
Functional Outcome ◽  
Disc Herniation ◽  
Radicular Pain ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Arm Pain ◽  
One Year ◽  
Epidural Steroid

AimsThe aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical disc herniation.Patients and MethodsA cohort of 102 patients was prospectively followed, after an epidural steroid injection for radicular symptoms due to lumbar disc herniation, in 57 patients, and cervical disc herniation, in 45 patients. Those patients with persistent pain who requested a second injection were prospectively followed for one year. Radicular and local pain were assessed on a visual analogue scale (VAS), functional outcome with the Oswestry Disability Index (ODI) or the Neck Pain and Disability Index (NPAD), as well as health-related quality of life (HRQoL) using the 12-Item Short-Form Health Survey questionnaire (SF-12).ResultsA second injection was performed in 17 patients (29.8%) with lumbar herniation and seven (15.6%) with cervical herniation at a mean of 65.3 days (sd 46.5) and 47 days (sd 37.2), respectively, after the initial injection. All but one patient, who underwent lumbar microdiscectomy, responded satisfactorily with a mean VAS for leg pain of 8.8 mm (sd 10.3) and a mean VAS for arm pain of 6.3 mm (sd 9) one year after the second injection, respectively. Similarly, functional outcome and HRQoL were improved significantly from the baseline scores: mean ODI, 12.3 (sd 12.4; p < 0.001); mean NPAD, 19.3 (sd 24.3; p = 0.041); mean SF-12 physical component summary (PCS) in lumbar herniation, 46.8 (sd 7.7; p < 0.001); mean SF-12 PCS in cervical herniation, 43 (sd 6.8; p = 0.103).ConclusionRepeat steroid injections are a justifiable form of treatment in symptomatic patients with lumbar or cervical disc herniation whose symptoms are not satisfactorily relieved after the first injection. Cite this article: Bone Joint J 2018;100-B:1364–71.

scholarly journals What Is the Role of Epidural Steroid Injections in Lumbar Spinal Disease with Moderate Disability?

2016 ◽  
Vol 4;19 (4;5) ◽  
pp. 293-298
Author(s):  
Jae-Young Hong
Keyword(s):  
Steroid Injection ◽  
Radicular Pain ◽  
Epidural Steroid Injection ◽  
Spinal Disease ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Pain Scores ◽  
One Year ◽  
Lumbar Spinal ◽  
Epidural Steroid

Epidural steroid injections have been gaining popularity as an alternative to surgical treatment of radicular pain with associated spinal derangement. To determine the effectiveness and indications of lumbar epidural steroid injections in patients with or without surgery, we performed a prospective observational study. We gathered data from 262 degenerative short-segment spinal disease patients (affected at one or 2 levels) with greater than 12 weeks of medication-resistant radicular pain without neurological deficits but with moderate disability (visual analog scale < 6.5; Oswestry Disability Index < 35). All patients received initial fluoroscopically guided transforaminal epidural steroid injections of the affected vertebral level(s) corresponding to their symptoms. Those with inadequate responses or who wanted subsequently surgery underwent decompression surgery. Clinical and demographic characteristics were assessed to compare the differences between the groups. Results: Of the 262 patients who received epidural steroid injections, 204 did not have operations for up to one year. However, 58 patients experienced inadequate relief of pain or wanted operations and therefore underwent surgery. At baseline, the 2 groups had similar mean disability indices and pain scores, as well as gender ratios, ages, and durations of symptoms (P > 0.05). In the patients who underwent surgery, the mean disability and pain scores were not significantly decreased after injection compared to those in the injection-alone group, although the scores for the injection plus surgery patients decreased significantly after surgery (P < 0.05). In contrast, patients who underwent epidural steroid injection alone experienced a significant decrease in disability and pain after injection, and that persisted up to one year of follow-up (P < 0.05). Epidural steroid injection can decrease the pain and disability in the majority of a moderate disability group for up to one year, although a significant number of patients underwent surgery regardless of injection. We recommend epidural steroid injection as a first-line treatment in patients with moderate disability that can be converted to surgery without significant delay. Key words: Epidural steroid injection, spinal surgery, lumbar spinal disease, lumbar radiculopathy, lumbar radicular pain

Vertebral Fracture Risk Is Reduced for Women Who Lose Femoral Neck Bone Mineral Density During Teriparatide Treatment

2008 ◽  
Vol 11 (3) ◽  
pp. 465 ◽  
Author(s):  
Nelson B. Watts ◽  
Paul D. Miller ◽  
Robert Marcus ◽  
Peiqi Chen ◽  
Jody Arsenault ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vertebral Fracture ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Mineral Density ◽  
Teriparatide Treatment ◽  
Vertebral Fracture Risk

Effect of Alendronate on Vertebral Fracture Risk in Women With Bone Mineral Density T Scores of −1.6 to −2.5 at the Femoral Neck: The Fracture Intervention Trial

2005 ◽  
Vol 80 (3) ◽  
pp. 343-349 ◽  
Author(s):  
Sara A. Quandt ◽  
Desmond E. Thompson ◽  
Diane L. Schneider ◽  
Michael C. Nevitt ◽  
Dennis M. Black
Keyword(s):  
Bone Mineral Density ◽  
Vertebral Fracture ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Intervention Trial ◽  
Mineral Density ◽  
Vertebral Fracture Risk

scholarly journals Lower Spine Volumetric Bone Density in Patients With a History of Epidural Steroid Injections

2018 ◽  
Vol 103 (9) ◽  
pp. 3405-3410 ◽  
Author(s):  
Yi Liu ◽  
John A Carrino ◽  
Alexander S Dash ◽  
Tariq Chukir ◽  
Huong Do ◽  
...  
Keyword(s):  
Median Number ◽  
University Hospital ◽  
Volumetric Bone Mineral Density ◽  
Mineral Density ◽  
Quantitative Ct ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
History Of ◽  
Epidural Steroid ◽  
The Impact

Abstract Context Epidural steroid injections (ESIs) are a common, effective treatment of lumbar radiculopathy and sciatica. Although the negative skeletal effects of oral glucocorticoids are well established, little is known about the impact of ESI on bone quality. Objective To investigate the relationship between ESI exposure and volumetric bone mineral density (vBMD) at the lumbar spine (LS) using central quantitative CT. Design Retrospective study. Setting University hospital outpatient facility. Patients All patients had CT scans of the LS between 2011 and 2016. Cases received at least three ESIs prior to the date of CT (n = 121). Controls were matched for age and sex (n = 121). Main Outcome Measures Cumulative ESI dose was calculated. vBMD was measured at T12 through L5 using QCT Pro phantomless software (MindWays). Results Mean age of subjects was 65 ± 14 years, and 49% were women. Median number of ESIs was 4 (range: 3 to 16). Median cumulative ESI dosage was 340 mg of triamcinolone or equivalent (range: 150 to 1400 mg). Compared with controls, ESI subjects had lower vBMD at each vertebral level. Higher cumulative dose was associated with lower mean vBMD at T12 to L5 (r = –0.22, P = 0.02). Conclusions Greater cumulative ESI dose was related to lower vBMD at the LS. To our knowledge, this is the first study to measure vBMD in patients treated with ESIs. Prospective studies are needed to confirm these findings and to help identify the best strategies for preventing bone loss in this population.

scholarly journals Changes in Bone Mineral Density in Postmenopausal Women Treated with Epidural Steroid Injections for Lower Back Pain

2012 ◽  
Vol 3;15 (3;5) ◽  
pp. 229-236
Author(s):  
Byeong-mun Hwang
Keyword(s):  
Bone Mineral Density ◽  
Back Pain ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Lower Back Pain ◽  
Mineral Density ◽  
Epidural Steroid Injections ◽  
Lower Back ◽  
One Year ◽  
Epidural Steroid

Background: Therapy with corticosteroids often results in bone loss and corticosteroid-induced osteoporosis. In previous studies, bone mineral density (BMD) has been examined after administration of relatively high oral doses of corticosteroids. However, practitioners use comparatively lower doses of corticosteroids for epidural steroid injections (ESI). The interactions and relationships between BMD and ESI remain to be determined. Objective: The aim of this study was to explore the relationship between BMD and ESI in postmenopausal women treated for lower back pain. Study design: This study was a retrospective evaluation. Methods: We reviewed the medical records of postmenopausal women with lower back pain who were treated with or without ESI. BMD was measured before treatment and one year after treatment in the lumbar spine, femoral neck, and total femur. A total of 90 postmenopausal women were divided into 2 groups. Group 1 patients received medications without ESI; Group 2 patients received ESI more than 4 times, with a cumulative administered triamcinolone dose of > 120 mg. Results: Decreased BMD was observed in patients treated with ESI. However, no significant difference was observed between or within the groups in terms of mean percentage change from baseline BMD. 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. Conclusions: These data suggest that ESI using triamcinolone (over 200 mg) for a period of one year will have a negative effect on BMD 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. Key words: bone mineral density, corticosteroid, epidural steroid injection, lower back pain, postmenopausal women, triamcinolone.

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