At NASS 2012, Shlomo Mandel, Henry Ford West Bloomfield Hospital, Bloomfield Hills, USA, stated that epidural steroid injections are associated with an increased risk of vertebral fractures.
Mandel told delegates that a prospective observational study by Al-Shoha et al (Spine 2012; epub), of which Mandel was a co-author, showed that a single epidural steroid injection in postmenopausal women was associated with a significant decline in hip bone mineral density (BMD) six months after the injection compared with baseline levels. He added that the study he was presenting investigated the potential association between epidural steroidal injections and the risk of vertebral fractures.
According to Mandel, the number of injections was associated with an increasing likelihood of vertebral fractures. Furthermore, each subsequent injection increased the risk of fracture by 1.21 times (p=0.03) adjusting for covariates. Mandel said: “Based on results of these two studies [the one on loss of BMD as well as the one on increased risk of vertebral fractures], we look more carefully at BMD, we order BMD assessment if it has not been previously recorded and, more importantly, we spend more time talking to our patients about the risk of reduced BMD and the possibility of complications. When I think there is higher likelihood of a fracture because of risk factors, I try to find non-steroidal based alternatives to treatment.”
In the USA, a potentially contaminated batch of epidural steroid injections has been associated with an outbreak of fungal meningitis. The death toll, at the time of press, was 29 with 356 cases of fungal meningitis reported overall. The FDA recently confirmed it has issued “FDA form 483” to the New England Compounding Center, which produced the batch of steroids associated with the outbreak. The form indicates that FDA inspectors believe that conditions or practices at the centre may have violated the Federal Food, Drug or Cosmetic Act or related regulations. However, the form is not a final FDA determination that the Act has been violated. The incidence has raised questions about the overall safety of epidural steroid injections.
Dr. Morningstar: Maybe taking care of the spinal problem is a better way to go? We have several therapies that can resolve spine and disc related back pain.
