Epidural Injections Increase Fracture Risk

Epidural steroid injections may increase your risk of spinal fractures, according to new research. A study found that every time a patient received an epidural injection, they elevated their risk of vertebral fractures by 21%.

Epidural steroid injections are frequently prescribed for relieving lower back pain and sciatica associated with lumbar disc herniation, spinal stenosis, and failed back surgery syndrome. Earlier research has shown the injections can decrease bone mineral density, but this is the first study to establish a link between lumbar epidural steroid injections and vertebral fractures.

Using medical records from the Henry Ford Health System, researchers compared 3,000 healthy controls to 3,000 patients aged 50 or older who had received lumbar epidural steroid injections for treating compressive neuropathic pain. They found that each injection episode increased the risk of vertebral fractures by a factor of 1.21-1.29.

Although epidural steroid injections provide short-term relief, there is still "less than robust" evidence on the long-term effects of the treatment, according to Andrew Schoenfeld, MD, of the William Beaumont Army Medical Center who commented on the study in an accompanying editorial. He pointed out that a popular study (Saal and Saal) commonly cited by proponents of epidural injections only involved patients with disc herniation, and the findings were not directly applicable to older adults with spinal stenosis.

"Although the available literature fails to support a substantial effect of steroid injection beyond the short-term period, the impact of vertebral fractures on quality of life as well as mortality is well understood," Schoenfeld wrote. Vertebral fractures have been linked to an elevated risk of mortality for both men and women, so any increased risk of vertebral fractures has serious implications, especially for the elderly. Researchers still need to investigate whether these risks are applicable to younger patients and those with normal bone mineral density.

The findings come at the heels of new guidelines from the the Congress of Neurological Surgeons and the American Association of Neurological Surgeons recommending against steroid injections for acute spinal cord injuries. The recommendations cite recent research linking steroid injections to an increased risk of death in patients with spinal cord injuries.

Patients can avoid the potential risks of epidural steroid injections by seeking effective, non-drug treatments for low-back pain like chiropractic care. Another recent study found that chiropractic was as effective as epidural injections for relieving pain, only with fewer side effects and costs.


DeVita Raeburn E. Spine injections may set stage for fractures. Medpage Today. June 7, 2013. Accessed June 13, 2013.

Mandel S, et al. A retrospective analysis of vertebral body fractures following epidural steroid injections. Journal of Bone and Spine Surgery 2013; 95: 961-964.

Schoenfeld AJ. Commentary on an article by Shlomo Mandel, MD, MPH, et al. "A retrospective analysis of vertebral body fractures following epidural steroid injections." Journal of Bone and Spine Surgery 2013; 95: e78(1-2).