WebMD Medical News
Louise Chang, MD
Oct. 25, 2012 -- Steroid injections to the spine were widely considered to be safe before being linked to an outbreak of fungal meningitis that by mid-week had killed 24 people in 17 states.
But a study out today raises new concerns about the injections that are used to treat millions of back pain sufferers every year -- and it has nothing to do with the tainted steroids blamed for the meningitis outbreak.
Epidural steroid shots are injected into the space around the spinal cord. The steroid works to curb inflammation in the area, leading to pain relief.
The study suggests that epidural shots increase the risk of spinal bone fractures, and researchers say patients with bone loss should be warned about this risk.
The research was presented today in Dallas at the annual meeting of the North American Spine Society.
Bone fractures of the spine are the most common fractures in patients with osteoporosis.
According to the American College of Rheumatology, one in two women over 50 and one in six men will suffer a fracture related to osteoporosis.
“For a patient population already at risk for bone fractures, steroid injections carry a greater risk than previously thought,” says researcher Shalom Mandel, MD, of Henry Ford Hospital in Detroit.
While other steroid treatments, such as those taken orally or by IV, have long been linked to bone loss, epidural steroid shots are thought to have little impact on bones because they are delivered directly to the problem area and believed to have less effect on the rest of the body.
But Mandel says this may not be the case.
“If epidural steroids are causing fractures, it is probably because the treatment is not localized,” he says. “The drug may be entering the circulatory system.”
The Henry Ford Hospital researchers examined data on 6,000 patients treated for back pain between 2007 and 2010.
Half the patients were treated with at least one epidural steroid shot and the other half had never had the treatment.
According to the analysis, spinal fracture risk increased by 29% with each steroid shot. This was an association though, and does not prove cause and effect.
Mandel still uses epidural steroid shots to treat patients with back pain, and he says he has even had the injections himself.
“They were very helpful,” he says. “There is definitely a place for this treatment.”
But he adds that patients at risk for fractures should be warned about the risk and followed closely if they have the treatment.
Orthopaedic surgeon Neil S. Ross, MD, of Lenox Hill Hospital in New York City, who reviewed the research, says the study does not convince him that epidural spinal shots increase fracture risk.
While he does not give the shots, Ross says he has referred many patients to doctors who do.
“I would not change my recommendations about this treatment based on this study,” he says, adding that more study is needed to confirm the findings.
These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.
SOURCES: North American Spine Society annual meeting, Dallas, Texas, Oct. 25, 2012. American College of Rheumatology.Shlomo Mandel, MD, Henry Ford Hospital, Detroit.Neil S. Roth, MD, Lenox Hill Hospital, New York.News release, Henry Ford Hospital.
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