Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences (AMS), Meibergdreef 9, 1105, Amsterdam, AZ, Netherlands.
Skeletal Radiol. 2020 May;49(5):787-793. doi: 10.1007/s00256-019-03362-2. Epub 2019 Dec 13.
To determine the effect of intra-articular corticosteroid injections on lumbar spine trabecular density.
This retrospective study was IRB-approved and HIPAA-compliant. We identified 50 patients (26 F, 24 M, mean age 69 ± 14 years) who had undergone at least three medium or large joint corticosteroid injections using insoluble corticosteroids and a subsequent non-contrast abdominal CT within 5 years of the first injection. About 126 age- and sex-matched controls without history of prior corticosteroid use who had undergone non-contrast abdominal CT were identified. Cumulative corticosteroid dose was calculated. Density measurements (HU) of trabecular bone of L1 to L4 were performed, and measurements of L1 were compared to established normative data. Groups were compared using a two-sided paired t-test or a chi-squared test. Linear regression analysis between cumulative corticosteroid dose and trabecular density was performed.
Patients underwent a mean of 4 corticosteroid injections (range 3 to 11) with a mean cumulative corticosteroid dose of 232 ± 100 mg triamcinolone equivalent (range 120 mg to 480 mg). There was no significant difference in trabecular density of L1 to L4 between cases and controls, and there was no significant difference in trabecular density at L1 compared to normative data (p > 0.2). There was no association between cumulative intra-articular corticosteroid dose and mean lumbar trabecular density (p > 0.3).
Patients who underwent repetitive intra-articular insoluble corticosteroid injections showed no increased risk of bone loss compared to controls. Cumulative intra-articular corticosteroid dose was not associated with lumbar trabecular density.
确定关节内皮质类固醇注射对腰椎小梁密度的影响。
本回顾性研究获得了机构审查委员会的批准和 HIPAA 合规性。我们确定了 50 名患者（26 名女性，24 名男性，平均年龄 69±14 岁），他们至少接受了 3 次使用不溶性皮质类固醇的大中关节皮质类固醇注射，并且在第一次注射后的 5 年内进行了非对比性腹部 CT。还确定了 50 名没有先前使用皮质类固醇史且接受过非对比性腹部 CT 的年龄和性别匹配的对照者。计算了累积皮质类固醇剂量。对 L1 至 L4 的小梁骨进行密度测量（HU），并将 L1 的测量值与既定的正常数据进行比较。使用双侧配对 t 检验或卡方检验比较组。进行了累积皮质类固醇剂量与小梁骨密度之间的线性回归分析。
患者接受了平均 4 次皮质类固醇注射（范围 3 至 11 次），平均累积皮质类固醇剂量为 232±100mg 曲安奈德等效物（范围 120mg 至 480mg）。病例组和对照组之间 L1 至 L4 的小梁骨密度无显着差异，并且 L1 的小梁骨密度与正常数据相比无显着差异（p>0.2）。累积关节内皮质类固醇剂量与平均腰椎小梁密度之间无关联（p>0.3）。
与对照组相比，接受重复关节内不溶性皮质类固醇注射的患者没有增加骨质流失的风险。累积关节内皮质类固醇剂量与腰椎小梁密度无关。
