Bone effects of epidural and intra-articular glucocorticoids: a systematic literature review

BRANCE ML; CHAVERO I; RAMIREZ STIEBEN LA; MAHER MC; ABDALA R; PÉREZ B; BAGUR A; DIEHL M; GIACOIA E; GRAF C; LARROUDÉ MS; MASSARI F; SÁNCHEZ A; DE LA VEGA M; MANSUR JL; BRUN LR

Miami

Congreso; 24 Congreso Panamericano de Reumatología (PANLAR 2022).; 2022

PANLAR

Background/Objective: Glucocorticoids (GC) are used in almost all medical specialities. Osteoporosis and vertebral and non-vertebral fractures are common in GC treated patients. Oral GC treatment leads to bone loss, particularly of trabecular bone. The benefits of GC used in rheumatological and traumatological disorders are known but they would have possible negative effects on bone. This systematic review aimed to evaluate the effects of epidural steroid injections (ESI), intra-articular and intramuscular GC on bone mineral density (BMD) and fragility fractures. Methods: A systematic review of Medline/PubMed, Cochrane, and LILACS up to November 2020 was conducted. Meta-analyses, systematic reviews, randomized and non-randomized controlled trials, prospective and retrospective studies comparing the effect of ESI, intra-articular or intramuscular GC used compared with a control group or baseline measurements were included.Results: Only a few studies showed a negative effect of ESI on bone in the qualitative analysis considering osteopenia and osteoporosis in lumbar spine, femoral neck and total hip and BMD as a surrogate outcome. On the other hand, the qualitative analysis showed that most of the studies found an increased risk of fragility fracture. However, only two studies could be included in the quantitative analysis, in which there were no differences between patients exposed to ESI versus controls in all evaluated regions. Conclusions: There was not enough evidence to suggest that ESI and intra-articular GC negatively affect bone loss. Longitudinal studies are needed to obtain more knowledge regarding the effect of ESI or intra-articular GC on BMD and fragility fractures.