Patients who receive epidural steroid injections are at increased risk of spinal fractures, according to new research published in the Journal of Bone and Joint Surgery. The study, which we reported on last October, adds to a growing body of evidence that epidural steroid injections do little to relieve back pain and may do more harm than good.
The procedure is increasingly being used to treat back pain of all kinds, with nearly 9 million spinal injections in the U.S. in 2011.
Researchers at the Henry Ford Health System studied the records of 3,000 patients, aged 50 and older, who received at least one steroid injection for back pain. They found that the risk of a spinal fracture increases 21 percent with each steroid injection, when compared to a control group that received no injections.
“For a patient population already at risk for bone fractures, steroid injections carry a greater risk that previously thought and actually pose a hazard to the bone,” said lead author Shlomo Mandel, MD, a Henry Ford orthopedic physician. Mandel recommends that patients being treated with steroid injections be told about the risk of fractures and undergo bone testing.
Bone fractures in the spine are the most common fracture in patients with osteoporosis. About 10 million Americans suffer from osteoporosis, which is caused by a decline in mineral bone density. About half of all women and a quarter of all men over the age of 50 will break a bone due to osteoporosis.
Patients with back pain are typically treated with anti-inflammatory drugs, painkillers and physical therapy. But if symptoms persist, an epidural steroid is often prescribed to alleviate pain.
Terri Anderson says she received about 20 epidural steroid injections for a ruptured disc in her back.
“They sent me through the mill. Every six months they wanted to do three steroid injections and they said it would help to avoid surgery,” Anderson told National Pain Report.
“It would help very temporarily, two to four weeks at best, and then the pain always came back. It always came back.”
The 51-year old resident of Hamilton, Montana blames the steroid shots for a hairline fracture in her foot that happened as she stepped out of the shower.
“I think the evidence is really starting to build here against the shots,” Anderson said.
In an editorial also published in the Journal of Bone and Joint Surgery, Andrew Schoenfeld, MD, an orthopedic surgeon at William Beaumont Army Medical Center in El Paso, called the Henry Ford study’s findings “the first scientifically rigorous effort to quantify the fracture risk associated with epidural steroid administration.”
But he also warned against drawing too many conclusions from one study and called for more research on the risks associated with epidural steroids.
“I would caution against the utilization of the study by Mandel et al. as a rationale for curtailing epidural injection procedures among all patients at present. Such interventions have been shown to be effective in patients with acute disc herniation, and the risk of vertebral fracture highlighted by Mandel et al. may not be inherent in all individuals, especially those who are younger in age and/or possess normal bone mineral density,” said Schoenfeld.
Other recent studies have also questioned the value of epidural steroid injections. A study by Australian researchers found that steroid shots do little to relieve back pain caused by sciatica and should only be considered as a last resort.
Henry Ford researchers have also reported that women can suffer significant bone density loss in their hip after being treated with a single steroid injection for back pain.
“We as consumers have the right to know about these adverse reactions to procedures that are so commonly prescribed,” said Dawn Gonzalez, a patient advocate for the Arachnoiditis Society for Awareness and Prevention (ASAP).
“I have been harmed by epidurals myself,” Gonzalez wrote in an email. “The risk of bone degradation after epidural steroid injections, as well as the risk of chemical meningitis, death, adhesive arachnoiditis, stroke, paralysis, and the list continues, just goes to show that the risks far outweigh the benefit of a possible very short term reduction in pain.”
Gonzalez is encouraging patients who have an adverse reaction to steroid injections to report them to the Food and Drug Administration at this website.