Effect of Epidural Steroid Injection on Bone Mineral Density and Markers of Bone Turnover in Postmenopausal Women

Abstract

A single ESI in postmenopausal women adversely affects BMD of the hip. This is in conjunction with a rise in bone remodeling activity, as evidenced by an increase in bone-specific alkaline phosphatase and CTX. In addition, when compared with an age-matched control population, our study population exhibited a greater decline in BMD. Our findings show that epidural administration of corticosteroids has a deleterious effect on bone, which should be considered when contemplating treatment options for radiculopathy. The resulting decrease in BMD, while slight, suggests that ESIs should be used with caution in those at a risk for fracture.

Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group

“…A group of postmenopausal women sensitive to bone loss who received an epidural injection of triamcinolone 80 mg were followed prospectively. A reduction in the mineral bone density of the hip and an increase in serum markers for bone turnover were observed at a 6‐fold increase compared to the average annual bone loss in a matched control group . Retrospective studies confirm that postmenopausal women who are given multiple ESIs have a lower mineral bone density score when they receive higher doses of corticosteroids (cumulative dose of triamcinolone >200 mg) .…”

Epidemiology of Vertebral Fractures

“…In some studies, the incidence rises with cumulative dose (146,147), but there may be an even stronger association between vertebral fracture incidence and mean daily dose (148,149). Local epidural glucocorticoid injections for spinal central or foraminal stenosis may also increase bone loss (150), and the risk of incident clinical vertebral fractures (151).…”

Neotendon infilling of a full thickness rotator cuff foot print tear following ultrasound guided liquid platelet rich plasma injection and percutaneous tenotomy: favourable outcome up to one year

“…Repeated cortisone injections are questionable given that studies have documented an increased loss of bone mineral density after corticosteroid injections in postmenopausal women 8, 9 with the potential to increase the risk of fractures in this group of patients. In addition corticosteroid does not have a role in the healing cascade of degenerative tears 10 .…”