Relationship between Bone Mineral Density and the Frequent Administration of Epidural Steroid Injections in Postmenopausal Women with Low Back Pain

BACKGROUND: Epidural steroid injection (ESI) is one of the most common nonsurgical treatments for low back pain. In general, corticosteroid therapy often results in bone loss and osteoporosis. In previous studies, bone mineral density (BMD) was evaluated after epidural injections of relatively small numbers and relatively low total doses of corticosteroids. However, the relationship between BMD and multiple ESIs remains to be elucidated.OBJECTIVE: To explore the relationship between BMD and multiple ESIs in postmenopausal women with low back pain.METHODS: Medical records of postmenopausal women with low back pain treated with or without ESIs were reviewed. BMD was measured in the lumbar spine, femoral neck and total femur after the treatments. A total of 71 patients were divided into two groups: group 1 included patients who had received non-ESI medications; and group 2 included those who had received ESIs >10 times, with a cumulative administered triamcinolone dose >200 mg.RESULTS: Patients in group 2 showed lower BMD in the femoral neck and total femur. However, no significant intergroup differences in the BMD of the lumbar spine were observed. The prevalences of osteoporosis and osteopenia in the lumbar spine and femoral neck were significantly higher in group 2; these patients also had lower femoral neck BMD Z-scores.CONCLUSIONS: Multiple ESIs (approximately 14 injections with a cumulative triamcinolone dose of approximately 400 mg) can reduce BMD in postmenopausal women with low back pain.

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Effect of Epidural Steroid Injection on Bone Mineral Density in Postmenopausal Women According to Antiosteoporotic Medication Use

January 2018 - Pain Physician ◽

10.36076/ppj/2016.19.389 ◽

2016 ◽

Vol 6;19 (6;7) ◽

pp. 389-396

Author(s):

Jeong Hun Suh

Keyword(s):

Bone Mineral Density ◽

Lumbar Spine ◽

Femoral Neck ◽

Postmenopausal Women ◽

Bone Mineral ◽

Steroid Injection ◽

Epidural Steroid Injection ◽

Mineral Density ◽

Group 2 ◽

Epidural Steroid

Background: No studies to date have compared bone mineral density (BMD) changes after epidural steroid injection (ESI) between postmenopausal patients taking antiosteoporotic medication and those who are not. Objective: The aim of the present study was to analyze the relationship between ESI and BMD changes in postmenopausal patients according to antiosteoporotic medication use. Study Design: Retrospective analysis. Setting: Department of Anesthesiology and Pain Medicine at Asan Medical Center, Korea. Methods: We retrospectively analyzed postmenopausal women who underwent ESI using dexamethasone. All women had received a diagnosis of lumbar spinal stenosis and their BMD had been measured before and after treatment. BMD was evaluated by dual-energy x-ray absorptiometry at the lumbar spine, femoral neck, femoral trochanter, and total femur, and was recorded as absolute g/cm2 and T-scores. A total of 126 patients were included in the final analysis. ESI patients were grouped as follows: group 1 (n = 74) ESI patients who took antiosteoporotic medication; group 2 (n = 52) ESI patients who did not take antiosteoporotic medication. Results: In group 1, there were no significant differences between baseline and post-treatment BMD absolute values (g/cm2) in the lumbar spine, femoral neck, femoral trochanter, and total femur. In group 2, significant changes in the post-treatment BMD absolute values (g/cm2) from baseline were observed in the femoral neck (–1.48 ± 3.84%), femoral trochanter (–2.80 ± 7.50%), and total femur (–2.23 ± 4.52%), but not in the lumbar spine (–2.23 ± 4.52%). Limitations: This study contained a small sample size, no control group, and no long-term follow-up of the BMD changes after ESI. Conclusions: Our data provide new evidence indicating that ESI causes BMD changes in postmenopausal women who do not take antiosteoporotic medication. Thus, we recommend that prophylactic antiosteoporotic treatment be considered for postmenopausal women who require ESI treatment. Keywords: Glucocorticoid, osteoporosis, bone mineral density, epidural steroid injection, antiosteoporotic medication, postmenopausal women, dexamethasone

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Low Bone Mineral Density, But Not Epidural Steroid Injection, Is Associated with Fracture in Postmenopausal Women with Low Back Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/441 ◽

2012 ◽

Vol 6;15 (6;12) ◽

pp. 441-449

Author(s):

Byeongmun Hwang

Keyword(s):

Bone Mineral Density ◽

Low Back Pain ◽

Back Pain ◽

Postmenopausal Women ◽

Bone Mineral ◽

Steroid Injection ◽

Epidural Steroid Injection ◽

Low Back ◽

Mineral Density ◽

Epidural Steroid

Background: Therapy with glucocorticoids often results in bone loss and glucocorticoidinduced osteoporosis. However, the relationship between epidural steroid injection (ESI), bone mineral density (BMD), and vertebral fracture remains to be determined. Objective: To establish a relationship between ESI, BMD, and vertebral fracture in postmenopausal women with low back pain. Study Design: This study was a retrospective, nonblinded, cross-sectional clinical study. Setting: University-based pain management center. Methods: We reviewed the medical records of postmenopausal women with low back pain who were treated with ESI. A total of 352 postmenopausal women were divided into 2 groups. Group 1 consisted of patients without fracture and Group 2 consisted of those with fractures. The results of BMD measurements, as well as any fragility fractures, the anatomical site involved, and the treatment administered, were also recorded. BMD was measured in the lumbar spine, femoral neck, and total femur after the treatment. Results: Of the 352 patients, 218 (62%) had no fractures while 134 (38%) sustained a fracture. The age was significantly higher among patients who sustained fractures, and BMD at the lumbar spine, total femur, and femoral neck regions was significantly lower among patients who sustained fractures. In each region, the prevalence of osteoporosis was significantly higher in patients with fracture than in patients without fracture (all P < 0.05). Age, height, and weight were associated with low BMD. However, our study showed no consistent correlation between BMD and the mean number of ESIs, mean total dose of glucocorticoids, or mean duration of ESIs. Limitations: First, this study is limited by the fact that it was retrospective. Second, the number of cases receiving very frequent, high-dose glucocorticoid injections was very small. Conclusions: Older age and lower BMD were associated with osteoporotic fracture in postmenopausal women treated for low back pain with ESI. The ESIs were not associated with low BMD or fracture. Key words: Bone mineral density, epidural steroid injection, fracture, glucocorticoids, low back pain, postmenopause.

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Impact of three-dimensional chemoradiation on pelvic bone mineral density, low back pain, and disability in cervical cancer: a prospective study

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-002290 ◽

2021 ◽

pp. ijgc-2020-002290

Author(s):

Divyesh Kumar ◽

Raviteja Miriyala ◽

Bhavana Rai ◽

Pooja Bansal ◽

Arun S Oinam ◽

...

Keyword(s):

Bone Mineral Density ◽

Cervical Cancer ◽

Low Back Pain ◽

Back Pain ◽

Femoral Neck ◽

Bone Mineral ◽

Menopausal Status ◽

Pelvic Bone ◽

Low Back ◽

Mineral Density

ObjectiveTo prospectively analyze the effect of three-dimensional chemoradiation on the bone mineral density of pelvic bones and its association with low back pain and disability in patients with locally advanced cervical cancer.MethodsIn biopsy proven locally advanced cervical cancer patients, bone mineral density and T scores for lumbar vertebrae 5, dorsal thoracic vertebrae 12, and T scores for the femoral neck were analyzed. Low back pain was scored using the visual analog scale while disability scoring was done using the Oswestry low back pain disability scale. Furthermore, a subgroup analysis for patients (classified according to menopausal status) was performed.ResultsIn total, 106 patients were analyzed. A statistically significant decline in mean bone mineral density was observed at all three sites (vertebrae 5 and 12, and the femoral neck) post-chemoradiation therapy compared with pretreatment bone mineral density (0.671 vs 0.828, −2.083 vs −1.531, −2.503 vs −1.626; all p<0.001). Similarly, in subgroup analyses, at all three sites, pre-menopausal patients showed a statistically significant association (0.876 vs 0.697, −1.203 vs −0.2.761, –1.403 vs −2.232; all p<0.001) while a non-significant association was observed for post-menopausal patients at vertebrae 12 (−1.707 vs −1.719; p=0.09) with a statistically significant association at vertebrae 5 and the femoral neck (0.803 vs 0.656, –1.746 vs −2.648; p<0.01). Although statistically significant low back pain and disability scores were observed overall and irrespective of menopausal status, no correlation between bone mineral density and low back pain and disability was observed.ConclusionPelvic bone mineral density decreases significantly after chemoradiation, irrespective of menopausal status. However, no correlation with low back pain and disability was observed. Pelvic bone mineral density analysis should be considered before chemoradiation in cervical cancer.

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Relation between intima-media thickness and bone mineral density in postmenopausal women: a cross-sectional study

Sao Paulo Medical Journal ◽

10.1590/s1516-31802011000300004 ◽

2011 ◽

Vol 129 (3) ◽

pp. 139-145 ◽

Cited By ~ 9

Author(s):

Daniela Fodor ◽

Cosmina Bondor ◽

Adriana Albu ◽

Laura Muntean ◽

Siao-pin Simon ◽

...

Keyword(s):

Lumbar Spine ◽

Femoral Neck ◽

Postmenopausal Women ◽

Atherosclerotic Plaque ◽

Vertebral Fractures ◽

Mineral Density ◽

Cross Sectional ◽

T Score ◽

Osteoporotic Vertebral Fractures ◽

The Relationship

CONTEXT AND OBJECTIVES: Controversy exists regarding the relationship between atherosclerosis and osteoporosis. The aim of this study was to determine the relationship between intima-media thickness (IMT) of the common carotid artery (CCA), presence of calcified atherosclerotic plaques and bone mineral density (BMD) evaluated by dual energy X-ray absorptiometry (DXA), in postmenopausal women. DESIGN AND SETTING: Cross-sectional study at Second Internal Medicine Clinic, Cluj-Napoca, Romania. METHODS: We studied the IMT (left and right CCA and mean IMT) and T-score (lumbar spine L2-L4, femoral neck and total hip) in 100 postmenopausal women (mean age 64.5 years). The presence of calcified atherosclerotic plaque and osteoporotic vertebral fractures was also noted. RESULTS: IMT in the left and right CCA and mean IMT were significantly associated with T-score measured for the lumbar spine L2-L4, femoral neck and total hip, with lower T-score, in the osteoporotic group than in the normal and osteopenic groups (P < 0.05). IMT had a significantly negative correlation with the lumbar spine T-score and femoral neck T-score; and mean IMT with lowest T-score. Mean IMT (P < 0.001), high blood pressure (P = 0.005) and osteoporotic vertebral fractures (P = 0.048) showed statistical significance regarding the likelihood of developing atherosclerotic plaque. CONCLUSIONS: In women referred for routine osteoporosis screening, the relationship between CCA, atherosclerosis and osteoporosis can be demonstrated using either cortical or trabecular BMD. Vertebral fractures may be considered to be a likelihood factor for atherosclerotic plaque development.

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