Steroid Shots for Back Pain Raise Risk of Bone Fractures

Patients who receive epidural steroid injections are at increased risk of spinal fractures, according to new research published in the Journal of Bone and Joint Surgery. The study, which we reported on last October, adds to a growing body of evidence that epidural steroid injections do little to relieve back pain and may do more harm than good.

The procedure is increasingly being used to treat back pain of all kinds, with nearly 9 million spinal injections in the U.S. in 2011.

Doctors prepare to make anesthesiaResearchers at the Henry Ford Health System studied the records of 3,000 patients, aged 50 and older, who received at least one steroid injection for back pain. They found that the risk of a spinal fracture increases 21 percent with each steroid injection, when compared to a control group that received no injections.

“For a patient population already at risk for bone fractures, steroid injections carry a greater risk that previously thought and actually pose a hazard to the bone,” said lead author Shlomo Mandel, MD, a Henry Ford orthopedic physician. Mandel recommends that patients being treated with steroid injections be told about the risk of fractures and undergo bone testing.

Bone fractures in the spine are the most common fracture in patients with osteoporosis. About 10 million Americans suffer from osteoporosis, which is caused by a decline in mineral bone density. About half of all women and a quarter of all men over the age of 50 will break a bone due to osteoporosis.

Patients with back pain are typically treated with anti-inflammatory drugs, painkillers and physical therapy. But if symptoms persist, an epidural steroid is often prescribed to alleviate pain.

Terri Anderson says she received about 20 epidural steroid injections for a ruptured disc in her back.

“They sent me through the mill. Every six months they wanted to do three steroid injections and they said it would help to avoid surgery,” Anderson told National Pain Report.

“It would help very temporarily, two to four weeks at best, and then the pain always came back. It always came back.”

The 51-year old resident of Hamilton, Montana blames the steroid shots for a hairline fracture in her foot that happened as she stepped out of the shower.

“I think the evidence is really starting to build here against the shots,” Anderson said.

In an editorial also published in the Journal of Bone and Joint Surgery, Andrew Schoenfeld, MD, an orthopedic surgeon at William Beaumont Army Medical Center in El Paso, called the Henry Ford study’s findings “the first scientifically rigorous effort to quantify the fracture risk associated with epidural steroid administration.”

But he also warned against drawing too many conclusions from one study and called for more research on the risks associated with epidural steroids.

“I would caution against the utilization of the study by Mandel et al. as a rationale for curtailing epidural injection procedures among all patients at present. Such interventions have been shown to be effective in patients with acute disc herniation, and the risk of vertebral fracture highlighted by Mandel et al. may not be inherent in all individuals, especially those who are younger in age and/or possess normal bone mineral density,” said Schoenfeld.

Other recent studies have also questioned the value of epidural steroid injections. A study by Australian researchers found that steroid shots do little to relieve back pain caused by sciatica and should only be considered as a last resort.

Henry Ford researchers have also reported that women can suffer significant bone density loss in their hip after being treated with a single steroid injection for back pain.

“We as consumers have the right to know about these adverse reactions to procedures that are so commonly prescribed,” said Dawn Gonzalez, a patient advocate for the Arachnoiditis Society for Awareness and Prevention (ASAP).

“I have been harmed by epidurals myself,” Gonzalez wrote in an email. “The risk of bone degradation after epidural steroid injections, as well as the risk of chemical meningitis, death, adhesive arachnoiditis, stroke, paralysis, and the list continues, just goes to show that the risks far outweigh the benefit of a possible very short term reduction in pain.”

Gonzalez is encouraging patients who have an adverse reaction to steroid injections to report them to the Food and Drug Administration at this website.

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6 Responses

  1. Dr. Haas says:

    One easy and very effective step to try before these extreme measures: visit a Doctor of Chiropractic (though not are created equal, find a good one with via references from family and friends) This will be a more effective and less expensive solution which will also address the cause of the issues you are experiencing instead of masking the symptoms.

  2. sue wood says:

    i had a spinal fusion 18 months ago that didnt work now waiting for injections in my spine and a corset after reading this i dont want them

  3. thomas bresnahan says:

    I received an Epidural Injection in 2009, the doctor in his dictation wrote “we did get withdrawal so we repositioned the needle and did 3 injections”. The withdrawal was spinal fluid, he punctured the dura layer but continued with the procedure. The steroid, DepoMedrol, leaked into my spinal cord. I know spend every day in horrible pain. I was 49 when this happened, other than sciatica pain for which I was getting the ESI, I was in great shape. This procedure and the drug which is NOT approved for use in or near the spine has destroyed my life.

  4. I did the standard protocol of lower back pain for 15 yrs until I stumbled on Travell-Simons’ Myofascial Pain Dysfunction in 1997. The text explains, in excellent detail, how to treat most musculoskeletal pain problems. The text in my opinion is the “bible” of myofascial pain therapy. Travell warns against using such a toxic and destructive substances such as corticosteroids in and around joint structures.
    1. The steroids cause accelerated atrophy which weakens ligament and tendon attachments to bone. Thus leading to spontaneous rupture of these structures.
    2. The steroids slow the natural healing cascade leading to weakening of the cartilages.
    3. The steroids will limit the proprioceptive feedback that will alter perception of pain and the natural negative feedback signals to warn against further joint damage.
    4. Alterations in alignment will further skew gait and balance, leading to falls and spontaneous weakness.
    5. Atrophy of artery supply will decrease the nutritional balance leading to accelerated degeneration.
    6. Accelerated decline in mineral bone density and spontaneous fractures.
    7. Travell noted back in the 1960s, that “joint pain” was not actually emanating from the joint proper.

    All this insight would make me think that these injections should be limited to a much smaller group of patients than the general population.

  5. Terri Lewis says:

    While there is much more work to do on this issue, this study confirms what is observable in the field insofar as the natural history of persons with back pain, who have been recipients of steroidal injections, and whose vetebral structures deteriorate over time. We already know that
    the increase in the use of steoridal injections is well correlated with the increase in back surgeries, with or without appliances. We applaud these physicians for their investigative work and caution that much more epidemiologic work remains to confirm these findings and elucidate these results.

    Terri Lewis, PhD
    Rehabilitation

  6. I got Arachnoiditis from an epidural injection. There isn’t a doubt that the epidural was the cause because I had no back surgery, only the epidural.

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