SATURDAY, Dec. 1 (HealthDay News) -- Older women who get steroid
injections in the spine to treat lower back pain may be at risk for
bone loss in their hips, a small study suggests.
It is well known that the anti-inflammatory steroid medications
used to treat diseases such as asthma and rheumatoid arthritis may
decrease a person's bone mass over time. But it hasn't been clear
whether steroid shots -- one treatment option for lower back pain
-- are connected to bone loss.
"It's been thought that [the steroids] might stay in the epidural space of the spine," explained study author Dr. Shlomo Mandel, an orthopedic physician at Henry Ford West Bloomfield Hospital, in Michigan.
Safety questions about steroid injections also have been raised
in recent months, as U.S. health officials investigate a deadly
outbreak of fungal meningitis linked to steroid shots produced by a
Massachusetts compounding pharmacy that has since shut down. More
than 510 illnesses and 36 deaths connected to the shots have been
reported so far, according to the U.S. Centers for Disease Control
and Prevention. (Women in the new study did not receive steroid
shots connected to the outbreak.)
To look at the bone-loss question, Mandel's team tracked
bone-density changes in 28 women who opted for steroid injections
to treat their back pain. They compared the findings with medical
records from a "control" group of women who were roughly the same
Over six months, women in the steroid group lost six times more
bone mass in the hip than the comparison group did, although the
absolute decrease was "slight," the researchers reported in the
Dec. 1 issue of the journal
But the extent to which the treatment itself is to blame for
bone loss isn't clear.
For one, women with chronic back pain may get little exercise,
which can accelerate the bone loss seen with aging, explained Dr.
Steven Cohen, a professor at Johns Hopkins School of Medicine in
Baltimore who focuses on pain research.
It's also not clear how "clinically significant" the bone loss
is, Cohen noted. That is, do steroid injections actually raise an
older woman's risk of hip fracture?
Still, Cohen and Mandel both suggested that doctors be cautious
about giving the injections to older women who are especially
vulnerable to the bone-thinning disease osteoporosis -- including
thin women who are white or Asian.
"This is not intended to alarm anyone," Mandel said. "I think that steroid injections have a place in treating low back pain. But we should use them judiciously."
In the real world, though, that may not always happen.
In general, steroid injections are potentially helpful when the
back pain involves some sort of nerve-root irritation -- such as
when a spinal disc is herniated and compressing a nerve.
But they're not so useful, Cohen noted, for pain from spinal
stenosis, a narrowing of the spinal column that often is at the
root of back pain in older people.
Doctors may overuse steroid injections -- sometimes because the
underlying cause of a patient's back pain is hard to ascertain.
There's also the financial aspect, Mandel pointed out. In the
United States, a single steroid spinal injection can cost a few
"I usually present steroid injections as a 'middle-of-the-road' option," Mandel said. That means giving them a try after conservative treatments, such as physical therapy and non-steroid anti-inflammatory drugs (NSAIDs), fail to help. Surgery is typically the last resort.
If you get no relief after a couple steroid injections, it is
probably unwise to keep trying, Cohen said. On the other hand, if
you feel better after one, don't get another -- at least not until
the pain returns.
"Doctors certainly shouldn't just habitually do a series of injections," Cohen said. "It should be based on a patient's response."
Further, larger studies are still needed to see how significant
the bone loss seen in this study might be. Mandel suggested that if
you are an older woman who is finding pain relief from steroid
injections, it would be wise to talk to your doctor about ways to
protect your bone mass -- such as taking calcium and vitamin D.
Cohen also stressed that other back-pain treatments have risks
as well. For older adults, he noted, long-term use of NSAIDs may
raise the risk of heart problems.
"And the risks from surgery or narcotic painkillers are definitely greater than the risks from epidural steroids," Cohen said. "Unfortunately, there is no risk-free treatment."
Just as unfortunate, Cohen added, there seems to be no cure for
low back pain. Even after surgery, the most extensive treatment,
symptoms typically return eventually.
Learn more about low back pain from the
U.S. National Institute of Neurological Disorders and
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