November 13, 2012 — Epidural steroid injections to treat back pain were widely considered a low-risk medical procedure until this October, when the shots were associated with an outbreak of fungal meningitis that has sickened more than 438 people and caused 32 deaths in 19 states. Now, there is growing research that the spinal injections may raise the risk of spinal bone fractures by 29% with each shot.
The research, presented in October at a meeting of the North American Spine Society, found that patients with osteoporosis or bone loss who receive the spinal injections may have a higher risk of fractures. People with osteoporosis already have an increased risk of spinal fractures, and steroid injections may further increase this risk.
Experts have known for many years that steroid treatments administered orally or intravenously are associated with an increased risk of bone loss, osteoporosis, and bone fractures. However, it was thought that the epidural injections were not associated with fractures because the drug was injected directly into the spine, instead of circulating throughout the patient’s entire body.
Researchers investigated 6,000 patients who were treated for back pain between 2007 and 2010. Of these patients, 3,000 received at least one steroid injection, and 3,000 did not receive an injection. The researchers found that the greater the number of steroid injections, the greater the patient’s risk of a spinal fracture. Patients had a 29% increase risk of spinal fractures with each steroid shot.
The researchers who conducted the study made the following recommendations:
- Patients who undergo epidural spinal injections should be warned about the potential increased risk of bone fractures
- Patients should undergo bone testing to check for signs of osteoporosis
Although the research identifies an association, it does not prove cause and effect. Patients at high risk of spinal fractures may suffer from back pain, and therefore undergo more spinal injections.
However, researchers warn that epidural steroid injection drugs may actually enter a patient’s circulatory system, similar to oral and/or intravenous steroids. Therefore, patients at high risk of spinal bone fractures should be monitored to check for emerging osteoporosis. The researchers also recommended conducting more studies to investigate the link between epidural spinal injections and bone fractures.
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