“It is also important to consider other (non-epidural) injected steroids the patient may receive, as large joint injections, for example, may contribute to any systemic effect on fracture risk as well as other endocrine side effects,” Dr. Bydon cautions.
This study’s findings are “consistent with known effects of corticosteroids on bone,” Dr. Roger Chou, director of the Pacific Northwest Evidence-based Practice Center at Oregon Health & Science University, told Reuters Health by email.
He notes, however, the uncertainty about whether ESIs have negative bone effects, “[because] the effects of corticosteroids are presumed to be mostly from systemic effects, and most of the corticosteroid that is injected into the epidural space is probably not having systemic effects; rather it has local effects in the epidural space.”
Dr. Chou cautions that all the studies in this review were observational. “The results should also be interpreted in the context of studies showing that the benefits of epidural steroid injections are small and short-lived,” he says.
Reference
- Kerezoudis P, Rinaldo L, Alvi MA, et al. The effect of epidural steroid injections on bone mineral density and vertebral fracture risk: A systematic review and critical appraisal of current literature. Pain Med. 2018 Jan 2. doi: 10.1093/pm/pnx324. [Epub ahead of print]
