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Steroid Injections for Back Pain: Fracture Risk?

Study of older adults doesn't prove that steroids are to blame, but experts advise caution


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.

"There are also a number of other options for spinal stenosis," Schoenfeld said. Normally, doctors would start conservatively, with physical therapy or medications such as nonsteroidal anti-inflammatory drugs or drugs that target nerve pain, including gabapentin (Neurontin) and pregabalin (Lyrica).

Steroid injections would be the middle ground for patients who don't respond to those treatments but want to put off surgery, Schoenfeld said. Surgery to relieve pressure on the nerves is often effective, said Schoenfeld, although someone with spinal stenosis may later develop the narrowing in another area of spine.


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