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Steroid Shots Associated with Bone Fracture Risk

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November 13, 2012 — Researchers have found an association between epidural steroid injections and an increased risk of spinal bone fractures. Until recently, spinal injections commonly used to treat back pain were thought to be a relatively low-risk medical procedure.

In October, several lots of spinal injections were associated with an outbreak of fungal meningitis, which has sickened hundred of people and caused at least 32 deaths. Now, researchers are warning that each spinal shot is associated with a 29% increased risk of bone fractures.

Epidural steroid injections are often given to patients who suffer from bone loss and back pain due to osteoporosis. Intravenous and oral administration of the steroid shots was associated with bone fractures many years ago, but doctors thought that the injectable steroids would be safer because the steroids were injected directly into the spine, instead of circulating in the patient’s system. Now it appears that epidural steroid injections may also have an increased risk of bone fractures.

In October, the researchers presented the conclusions of their study at a conference for the North American Spine Society. According to the study’s lead author, “For a patient population already at risk for bone fractures, steroid injections carry a greater risk than previously thought and actually pose a hazard to the bone.”

The researchers based their conclusion on a retrospective analysis of 6,000 patients, including 3,000 who received spinal shots and 3,000 who did not. The data was collected between 2007 and 2010. They found that the risk of spinal fractures increased with the number of epidural steroid shots.

Although this does not prove a cause-and-effect conclusion (patients susceptible to bone fractures might also require more spinal shots), it does raise concerns for high-risk populations. The researchers recommended conducting additional studies to further investigate the link.

Until more research is conducted, the researchers recommended taking the following precautions:

  • Warn patients about the potential increased risk of bone fractures associated with epidural spinal injections
  • Conduct bone tests to check for osteoporosis, especially in patients who undergo multiple spinal injections

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