Each epidural steroid injection increases spinal fracture risk 29%: Henry Ford Hospital

Patients treated with an epidural steroid injection for low back pain & sciatica relief are at greater risk of bone fractures in the spine than previously thought, according to a Henry Ford Hospital study presented Oct 25 at the North American Spine Spine Society conference in Dallas.

The risk of fracture increased 29% with each steroid injection, the researchers say – a finding they believe raises patient safety concerns. Back pain patients are typically treated with anti-inflammatory drugs and physical therapy, and if symptoms persist, an epidural steroid has often been prescribed to alleviate pain and improve function. For many, the result allows a patient to progress with rehab stretching and exercise.

Steroid use had been linked to diminished bone quality, but based on the new data, “For a patient population already at risk for bone fractures, steroid injections carry a greater risk than previously thought and actually pose a hazard to the bone,” says orthopedic surgeon Shlomo Mandel, MD, the study’s lead author.

Dr. Mandel recommends that patients being treated with steroid injections:

• Be told about the risks associated with future fractures

• And undergo bone testing.

Bone fractures in the spine are the most common fracture in patients with osteoporosis, affecting an estimated 750,000 people annually, and roughly 40% of all women by age 80 & older.

The Study

In this retrospective study, the research team compared data on 6,000 patients who had been treated for back pain between 2007 and 2010 – 3,000 patients who received at least one steroid injection, and 3,000 patients who did not receive injection.

The average age of patients was 66 years; 3,840 were women and 2,160 were men. The researchers also analyzed the incidence of bone fractures in each group. Using the survival analysis technique, they found that the number of steroid injections is linked with an increased likelihood of fracture.

The study was funded by Henry Ford Hospital.

Source: Based on Henry Ford Health System news release, Oct 27, 2012

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