Steroid Injections for Back Pain: Fracture Risk?
Study of older adults doesn't prove that steroids are to blame, but experts advise caution
The findings do not prove that the injections themselves caused the fractures, said Dr. Andrew Schoenfeld, who wrote a commentary published with the study.
But the results raise an important potential risk that needs to be weighed against the benefits. "This brings to light something that should be part of doctor-patient discussions," said Schoenfeld, who is based at William Beaumont Army Medical Center in El Paso, Texas.
He cautioned, however, that the findings may apply only to certain patients -- namely, older adults with waning bone mass. "We don't know if this would apply to elderly people with normal bone mass," Schoenfeld said.
Complicating matters, steroid injections seem to benefit only certain types of spine-related pain. The "best medical evidence" that they work is for cases of leg pain caused by a herniated disc compressing a nerve, Schoenfeld said.
Herniated discs are a common source of pain for younger people. "If you're 35 and have a herniated disc, these findings don't really apply to you at all," Schoenfeld said.
When it comes to spinal stenosis -- the most common source of problems for older adults -- steroid injections can aid leg pain and cramping. But there is "very sparse" evidence that the injections ease pain concentrated in the low back, Schoenfeld said.
If that's the primary problem for an older adult, the potential side effect of a vertebral fracture could outweigh the small chance of benefit.
Epidural steroids have been getting negative press of late. U.S. officials are currently investigating a deadly outbreak of fungal meningitis linked to epidural steroids produced by one Massachusetts pharmacy. And a study released in March found that steroid injections were less effective at relieving back pain than surgery and other treatments.
But both Schoenfeld and Mandel said the treatment still has a role in treating certain spine-related pain. They said older patients who have already found leg-pain relief from steroid injections may want to stick with them. But they should at least be aware of the potential fracture risk.
If they opt to continue the treatment, Mandel said, they may want to talk with their doctor about ways to preserve their bone mass -- such as calcium and vitamin D supplements.