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The analysis aimed to assess the present literature determining the epidural steroid injections (ESIs) impact on bone mineral density (BMD) and vertebral fracture risk.
Epidural steroid
injections (ESIs) is the administration of corticosteroid into the spinal
epidural space. It affects bone mineral density via multiple mechanisms.
Various studies reported the conflicting results regarding the effect of ESIs
on bone mineral density (BMD). Therefore, in the present study, it was stated
that ESIs should be recommended with caution, especially in patients at risk
for osteoporotic fractures, such as women of postmenopausal age.
The analysis aimed to assess the present literature determining the epidural steroid
injections (ESIs) impact on bone mineral density (BMD) and vertebral fracture
risk.
PubMed, Scopus, Embase, and Cochrane was searched.
A total of eight studies comprising 7,233 patients aged
between 49 to 74 years along with a mean follow-up between six and 60 months
were found. Dexamethasone, Methylprednisolone (MP), and Triamcinolone were the
steroids that utilized in the analysis with one to 14.7 mean number of
injections and 80 to 8,130 mg average cumulative MP dose. Four out of six
studies showed an association between epidural steroids and decreased BMD, and
one out of two studies exhibited enhanced risk of vertebral fracture. A
cumulative MP dose of 200 mg over a one-year and 400 mg over three years showed
a relationship with reduced BMD; but not in doses less than 3 g of MP
equivalents for healthy men and 200 mg for postmenopausal women. The patients
who were taking anti-osteoporotic medicines during the treatment showed reduced
risks of osteoporosis and osteopenia.
ESIs should be prescribed with caution, particularly
among patients who are at risk for osteoporotic fractures like females of
postmenopausal age. Anti-osteoporotic medicine might be considered before ESI.
Pain Med. 2018 Jan 2
The Effect of Epidural Steroid Injections on Bone Mineral Density and Vertebral Fracture Risk: A Systematic Review and Critical Appraisal of Current Literature
Panagiotis Kerezoudis et al.
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