Saturday, January 12, 2013

Steroids (Oral and Injections) and Osteoporosis

If you have a chronic inflammatory or autoimmune disorder such as asthma, COPD, rheumatoid arthritis, inflammatory bowel disease, polymyalgia rheumatica or multiple sclerosis, most likely you were prescribed an oral glucocorticoid (corticosteroid) medication such as cortisone or prednisone. Unfortunately, long-term use of these steroids carry high risks for developing some very nasty side effects...including osteoporosis. In fact, 30 to 50% of patients prescribed prednisone, long-term, will sustain a fracture. Even low-dose prednisone, taken for just six months, can weaken bone and cause fractures.

Is the same true for steroid injections? Specifically, can the injection of corticosteroids into the spine for the treatment of low-back and leg pain increase your risk for fracture?

In my chiropractic practice I see patients every day who are suffering from severe lower back and leg pain. Thankfully, through a treatment regimen of gentle chiropractic spinal mobilization and manipulation techniques plus core exercise therapy, pain in most of these patients can be reduced and eventually eliminated.

However, there are those individuals who, due to the severity of their disc condition, do not achieve satisfactory relief of pain and are candidates for epidural steroid injections.

The fracture risk with steroid injections was recently addressed by Dr. Ahmad Al-Shoha and colleagues from Summa Health System in Akron, Ohio when they studied the effects of epidural steroid injections on bone mineral density (BMD) in postmenopausal women. What they found was that "there was a significant decline in hip BMD...at 6 months compared with baseline...A single epidural steroid injection in postmenopausal women adversely affects bone mineral density of the hip...Our findings show that epidural administration of corticosteroids has a deleterious effect on bone, which should be considered when contemplating treatment options for radiculopathy [sciatic leg pain]. The resulting decrease in bone mineral density, while slight, suggests that epidural steroid injections should be used with caution in those at a risk for fracture."

Bottom line: "Indeed, the osteoporotic effects of glucocorticoids may be no different when administered epidurally than through other routes such as oral or inhalation."

Although the beneficial effects of steroids on the underlying disease may partially offset the detrimental effects on bone, patients on long-term steroid treatment should have bone density monitored, and measures taken to try and preserve bone.


Al-Shoha A et al., 2012. Effect of epidural steroid injectin on bone mineral density and markers of bone turnover in postmenopausal women. Spine 37(25):E1567-71.
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