Steroid injections for back pain linked to spinal fracture risk - NewsChannel5.com | Nashville News, Weather & Sports

Steroid injections for back pain linked to spinal fracture risk

Updated: June 14, 2013 10:02 AM EDT
© iStockphoto.com / Sebastian Kaulitzki © iStockphoto.com / Sebastian Kaulitzki
By Amy Norton
HealthDay Reporter

FRIDAY, June 14 (HealthDay News) -- Older adults who get steroid injections to ease lower back and leg pain may have increased odds of suffering a spine fracture, a new study suggests.

It's not clear, however, whether the treatment is to blame, according to experts. But they said the findings, which were published June 5 in the Journal of Bone and Joint Surgery, suggest that older patients with low bone density should be cautious about steroid injections.

The treatment involves injecting anti-inflammatory steroids into the area of the spine where a nerve is being compressed. The source of that compression could be a herniated disc, for instance, or spinal stenosis -- a condition common in older adults, in which the open spaces in the spinal column gradually narrow.

Steroid injections can bring temporary pain relief, but it's known that steroids in general can cause bone density to decrease over time. And a recent study found that older women given steroids for spine-related pain showed a quicker rate of bone loss than other women their age.

The new findings go a step further by showing an increased fracture risk in steroid patients, said Dr. Shlomo Mandel, the lead researcher on both studies.

Still, he said, the study, which was based on medical records, had "a lot of limitations."

"I want to be careful not to imply that people shouldn't get these injections," said Mandel, an orthopedic physician with the Henry Ford Health System in Detroit.

The findings are based on medical records from 3,000 Henry Ford patients who had steroid injections for spine-related pain, and another 3,000 who got other treatments. They were 66 years old, on average.

Overall, about 150 patients were later diagnosed with a vertebral fracture, Mandel said. Vertebral fractures are cracks in small bones of the spine, and in an older adult with low bone mass they can happen without any major trauma.

On average, Mandel's team found, steroid patients were at greater risk of a vertebral fracture -- with the risk climbing 21 percent with each round of injections.

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.

"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.

More information

Learn more about spinal stenosis from the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Health News Copyright © 2013 HealthDay. All rights reserved.

  • Medical News HeadlinesMedical News HeadlinesMore>>

  • Ocular Melanoma: Saving Lives, Saving Eyes

    Ocular Melanoma: Saving Lives, Saving Eyes

    Friday, April 11 2014 5:15 PM EDT2014-04-11 21:15:07 GMT
    Ocular melanoma, also called uveal melanoma, is a rare type of melanoma that targets the eye. It can be a deadly if it isn't spotted early enough. Now, there's a way to treat patients that's saving lives and saving eyes.more>>
    Ocular melanoma, also called uveal melanoma, is a type of melanoma that targets the eye. It affects about 2,000 people a year in the United States. Although rare – it can be a deadly if it isn't spotted early enough. Now, there's a way to treat patients that's saving lives and saving eyes.more>>
  • Memory Palace: Coping With Chemo Brain

    Memory Palace: Coping With Chemo Brain

    Thursday, April 10 2014 5:15 PM EDT2014-04-10 21:15:09 GMT
    More than 13 million Americans are living with some form of cancer. Harsh treatments like chemo and radiation save lives, but they will also change lives. Now, many cancer survivors are learning how to cope with chemo brain.more>>
    More than 13 million Americans are living with some form of cancer. Harsh treatments like chemo and radiation save lives, but they will also change lives. Now, many cancer survivors are learning how to cope with chemo brain.more>>
  • Pedaling For A Cure

    Pedaling For A Cure

    Wednesday, April 9 2014 5:15 PM EDT2014-04-09 21:15:09 GMT
    Five years ago, Leslie Trudeau's world came crashing down. At just 22 years old, her son Taylor lost his battle with leukemia. That's why Trudeau is pedaling for a cure.more>>
    Five years ago, Leslie Trudeau's world came crashing down. At just 22 years old, her son Taylor lost his battle with leukemia. That's why Trudeau is pedaling for a cure.more>>
  • Bringing Hearts Back To Life: New Improved Defibrillator

    Bringing Hearts Back To Life: New Improved Defibrillator

    Tuesday, April 8 2014 5:15 PM EDT2014-04-08 21:15:13 GMT
    CPR and a portable defibrillator helped keep Eric Robinson alive after he went into cardiac arrest. And now a newly FDA approved Biotronik implantable cardiac defibrillator, or ICD, constantly monitors his heart.more>>
    A year ago, while jamming with his son's band, Eric Robinson went into cardiac arrest. CPR and a portable defibrillator helped keep Robinson alive. And now a newly FDA approved Biotronik implantable cardiac defibrillator, or ICD, constantly monitors his heart.more>>
  • Helping High Risk Hearts

    Helping High Risk Hearts

    Monday, April 7 2014 5:15 PM EDT2014-04-07 21:15:09 GMT
    Ironing is not exactly Barbara Roy's favorite activity, but it's something she's glad she can do again. Her doctor diagnosed her with severe aortic stenosis.more>>
    Ironing is not exactly Barbara Roy's favorite activity, but it's something she's glad she can do again. Her doctor diagnosed her with severe aortic stenosis.more>>
  • Hernias In Newborns: Lincoln's Story

    Hernias In Newborns: Lincoln's Story

    Friday, April 4 2014 5:15 PM EDT2014-04-04 21:15:07 GMT
    Congenital diaphragmatic hernias occur in about one in every 2,000 births. They can be deadly, but now doctors are using a more aggressive treatment approach.more>>
    Congenital diaphragmatic hernias occur in about one in every 2,000 births. They can be deadly, but now doctors are using a more aggressive treatment approach.more>>
  • Predicting Bad Hearts

    Predicting Bad Hearts

    Thursday, April 3 2014 5:15 PM EDT2014-04-03 21:15:09 GMT
    Every year, more than 700,000 Americans have a heart attack. Now, researchers at Baylor Research Institute at Dallas have uncovered a biomarker that may help them spot the disease sooner.more>>
    Every year, more than 700,000 Americans have a heart attack. And 600,000 die of heart disease. Now, researchers at Baylor Research Institute at Dallas have uncovered a biomarker that may help them spot the disease sooner; and they did it by pure accident.more>>
  • Giving Shannon A Voice Of Her Own

    Giving Shannon A Voice Of Her Own

    Wednesday, April 2 2014 5:15 PM EDT2014-04-02 21:15:05 GMT
    More than half a million children under age 15 has a severe communication disorder impairing their ability to speak or communicate with others. Now, advances in technology are giving them a voice—some for the first time.more>>
    More than half a million children under age 15 has a severe communication disorder impairing their ability to speak or communicate with others. Now, advances in technology are giving them a voice—some for the first time.more>>
  • Getting On Your Nerves To Save Your Heart

    Getting On Your Nerves To Save Your Heart

    Tuesday, April 1 2014 5:15 PM EDT2014-04-01 21:15:06 GMT
    Heart failure is the fastest growing cardiovascular disorder in the U.S., affecting more than 6 million people. However, now a new device that gets on your nerves could help save those with heart failure.more>>
    Heart failure is the fastest growing cardiovascular disorder in the U.S., affecting more than 6 million people. It occurs when a person's heart is too weak to pump and circulate blood in the body. However, now a new device that gets on your nerves could help save those with heart failure.more>>
  • New Way To Hear For Grayson: Brain Stem Implant

    New Way To Hear For Grayson: Brain Stem Implant

    Monday, March 31 2014 5:15 PM EDT2014-03-31 21:15:07 GMT
    Imagine being born profoundly deaf: missing the vital nerve needed for you to hear. Without it, you had no options; until now.more>>
    Imagine being born profoundly deaf: missing the vital nerve needed for you to hear. Without it, you had no options; until now.more>>
*DISCLAIMER*: The information contained in or provided through this site section is intended for general consumer understanding and education only and is not intended to be and is not a substitute for professional advice. Use of this site section and any information contained on or provided through this site section is at your own risk and any information contained on or provided through this site section is provided on an "as is" basis without any representations or warranties.
Powered by WorldNow
Powered by WorldNow
All content © Copyright 2000 - 2014 NewsChannel 5 (WTVF-TV) and WorldNow. All Rights Reserved.
For more information on this site, please read our Privacy Policy and Terms of Service.