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Steroid Injections for Back Pain Linked to Increased Risk of Bone Fractures

Fracture risk increased by 29% with each injection (Oct. 25)

Patients treated with an epidural steroid injection for back pain relief are at increased risk of bone fractures in the spine, according to a study conducted at Henry Ford Hospital in Detroit, Michigan.

The researchers say that the risk of fracture increased 29% with each steroid injection — a finding they believe raises patient safety concerns.

"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," said lead author Shlomo Mandel, MD.

Mandel recommends that patients being treated with steroid injections be told about the risks associated with future fractures and undergo bone testing.

The new study was presented on October 25 at the annual meeting of the North American Spine Society in Dallas, Texas.

Bone fractures in the spine are the most common fracture in patients with osteoporosis, affecting an estimated 750,000 people annually. Approximately 40% percent of women aged 80 years and older experience bone fractures in the spine.

Patients are typically treated with anti-inflammatory drugs and physical therapy. If symptoms persist, an epidural steroid is often prescribed to alleviate pain and to improve function. However, steroid use has been linked to diminished bone quality.

In a retrospective study, researchers compared data from 6,000 patients 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 an injection. The patients’ average age was 66 years, and most (64%) were women. 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 was linked with an increased likelihood of fracture.

The patients in this study did not receive the steroid injection medication that is at the center of the current meningitis outbreak.

Source: Henry Ford Health System, October 25, 2012.

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