1. 2012;15;229-236Changes in Bone Mineral Density in Postmenopausal Women Treated with Epidural Steroid Injections for Lower Back Pain
   Observational Report
   Seong-Sik Kang, MD, Ph D, Byeong-Mun Hwang, M.D, Ph D, Heejeong Son, MD, PhD, Il-Young Cheong, MD, Sang-Jin Lee, MD, and Tae-Yoon Chung, MD.

BACKGROUND: Therapy with corticosteroids often results in bone loss and corticosteroid-induced osteoporosis. In previous studies, bone mineral density (BMD) has been examined after administration of relatively high oral doses of corticosteroids. However, practitioners use comparatively lower doses of corticosteroids for epidural steroid injections (ESI). The interactions and relationships between BMD and ESI remain to be determined.

OBJECTIVE: The aim of this study was to explore the relationship between BMD and ESI in postmenopausal women treated for lower back pain.

STUDY DESIGN: This study was a retrospective evaluation.

METHODS: We reviewed the medical records of postmenopausal women with lower back pain who were treated with or without ESI. BMD was measured before treatment and one year after treatment in the lumbar spine, femoral neck, and total femur. A total of 90 postmenopausal women were divided into 2 groups. Group 1 patients received medications without ESI; Group 2 patients received ESI more than 4 times, with a cumulative administered triamcinolone dose of > 120 mg.

RESULTS: Decreased BMD was observed in patients treated with ESI. However, no significant difference was observed between or within the groups in terms of mean percentage change from baseline BMD.

LIMITATIONS: First, this study is limited by the fact that it was retrospective. Second, our study did not consider the use of ESI with high-dose corticosteroids. Third, our study did not include any long-term assessments of the effects of ESI on BMD.

CONCLUSIONS: These data suggest that ESI using triamcinolone (over 200 mg) for a period of one year will have a negative effect on BMD in postmenopausal women treated for lower back pain. However, ESI therapy using a maximum cumulative triamcinolone dose of 200 mg in one year would be a safe treatment method with no significant impact on BMD.