Pain Relief Ups Fracture Risk

Epidural steroid injections used for back pain increase chances of bone fracture

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) As baby boomers continue to age, they experience more aches and pains than in their more youthful days. With this comes a desire to treat and prevent pain, sometimes at the cost of other health concerns.

A recent study investigated whether lumbar epidural steroid injections (LESIs) increase the risk of fractures in the vertebrae.

The study found that each injection increased fracture risk by 29 percent.

"Ask whether you should be tested for osteoporosis."

Shlomo Mandel, MD, a Henry Ford Hospital orthopedic surgeon, and colleagues conducted a study that compared 3,000 patients receiving LESIs and 3,000 controls. Those receiving LESIs had a selected set of back pain diagnoses and at least one LESI. The controls all had a spinal disorder and no LESIs.

The patient and control groups were matched on age, predicted effect of the treatment, sex, ethnicity, hyperthyroidism and steroid use. Their average age was 66, and there were more women than men.

Steroid use has been linked in the past to an increased chance of fracture. The added exposure to the steroids is likely what increases the rate of risk.

LESIs are a common procedure to ease spinal irritation and back pain. A combination of anti-inflammatory medicines and local anesthetic are injected into the space around the lumbar vertebrae and nerve roots.

Bone fractures are more common in patients with osteoporosis, a disease that affects more women than men. Forty percent of women over the age of 80 experience fractures in the spine.

Bone fractures are also more common in the elderly than in other age groups due to advanced disease of the spine and more frequent bone fragility.

The pros and cons of treatments like LESIs must be weighed carefully, particularly when it comes to the elderly population.

The authors suggest that any patient treated with LESIs be informed of the risks and undergo bone testing.

The study was presented at the annual meeting of the North American Spine Society in Dallas and was funded by the Henry Ford Hospital. Findings presented at academic conferences should be considered preliminary until published in a peer-reviewed journal.

The study took place prior to the recent meningitis outbreak and did not involve the contaminated steroid injections. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
November 15, 2012
Last Updated:
November 16, 2012