The effect of epidural steroid injections on bone mineral density and vertebral fracture risk

Epidural steroid injections (ESIs) is the administration of corticosteroid into the spinal epidural space. It affects bone mineral density via multiple mechanisms. Various studies reported the conflicting results regarding the effect of ESIs on bone mineral density (BMD). Therefore, in the present study, it was stated that ESIs should be recommended with caution, especially in patients at risk for osteoporotic fractures, such as women of postmenopausal age.

The analysis aimed to assess the present  literature determining the epidural steroid injections (ESIs) impact on bone mineral density (BMD) and vertebral fracture risk.

PubMed, Scopus, Embase, and Cochrane was searched.

A total of eight studies comprising 7,233 patients aged between 49 to 74 years along with a mean follow-up between six and 60 months were found. Dexamethasone, Methylprednisolone (MP), and Triamcinolone were the steroids that utilized in the analysis with one to 14.7 mean number of injections and 80 to 8,130 mg average cumulative MP dose. Four out of six studies showed an association between epidural steroids and decreased BMD, and one out of two studies exhibited enhanced risk of vertebral fracture. A cumulative MP dose of 200 mg over a one-year and 400 mg over three years showed a relationship with reduced BMD; but not in doses less than 3 g of MP equivalents for healthy men and 200 mg for postmenopausal women. The patients who were taking anti-osteoporotic medicines during the treatment showed reduced risks of osteoporosis and osteopenia.

ESIs should be prescribed with caution, particularly among patients who are at risk for osteoporotic fractures like females of postmenopausal age. Anti-osteoporotic medicine might be considered before ESI.