Endocrinology Division, Hospital for Special Surgery, New York, NY 10021, USA.
Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA.
J Clin Endocrinol Metab. 2022 Jul 14;107(8):e3281-e3287. doi: 10.1210/clinem/dgac287.
Over 9 million epidural steroid injections (ESIs) are performed annually in the United States. Although these injections effectively treat lumbar radicular pain, they may have adverse consequences, including bone loss.
To investigate acute changes in bone turnover following ESI. We focused on postmenopausal women, who may be at greatest risk for adverse skeletal consequences due to the combined effects of ESIs with aging and estrogen deficiency.
Single-center prospective observational study. Postmenopausal women undergoing lumbar ESIs and controls with no steroid exposure were included. Outcomes were serum cortisol, markers of bone formation, osteocalcin, and procollagen type-1 N-terminal propeptide (P1NP), and bone resorption by C-telopeptide (CTX) measured at baseline, 1, 4, 12, 26, and 52 weeks after ESIs.
Among ESI-treated women, serum cortisol declined by ~50% 1 week after injection. Bone formation markers significantly decreased 1 week following ESIs: osteocalcin by 21% and P1NP by 22%. Both markers remained suppressed at 4 and 12 weeks, but returned to baseline levels by 26 weeks. There was no significant change in bone resorption measured by CTX. Among controls, there were no significant changes in cortisol or bone turnover markers.
These results provide evidence of an early and substantial reduction in bone formation markers following ESIs. This effect persisted for over 12 weeks, suggesting that ESIs may have lasting skeletal consequences. Given the large population of older adults who receive ESIs, further investigation into the long-term skeletal sequelae of these injections is warranted.
在美国，每年有超过 900 万例硬膜外类固醇注射（ESI）。虽然这些注射可以有效地治疗腰椎神经根痛，但它们可能会产生不良后果，包括骨质流失。
研究 ESI 后骨转换的急性变化。我们专注于绝经后妇女，由于 ESI 与衰老和雌激素缺乏的综合影响，她们可能面临最大的骨骼不良后果风险。
单中心前瞻性观察研究。纳入接受腰椎 ESI 和无类固醇暴露的对照组的绝经后妇女。在 ESI 后 1、4、12、26 和 52 周时测量血清皮质醇、骨形成标志物、骨钙素和前胶原 I 型 N 端前肽（P1NP）以及 C 端肽（CTX）来评估骨吸收。
在接受 ESI 治疗的女性中，血清皮质醇在注射后 1 周下降约 50%。骨形成标志物在 ESI 后 1 周显著下降：骨钙素下降 21%，P1NP 下降 22%。这两个标志物在 4 周和 12 周时仍处于抑制状态，但在 26 周时恢复到基线水平。CTX 测量的骨吸收没有显著变化。在对照组中，皮质醇或骨转换标志物均无显著变化。
这些结果提供了 ESI 后骨形成标志物早期和明显减少的证据。这种影响持续了 12 周以上，表明 ESI 可能对骨骼有持久的影响。鉴于接受 ESI 的老年人群体庞大，进一步研究这些注射的长期骨骼后遗症是必要的。
