Efectos óseos de los glucocorticoides epidurales e intraarticulares: revisión sistemática de la literatura

Contenido principal del artículo

María Lorena Brance
Ignacio Chavero
Luis Agustín Ramírez Stieben
María Cielo Maher
Rubén Abdala
Betiana Pérez
Alicia Bagur
María Diehl
Evangelina Giacoia
César Graf
María Silvia Larroudé
Fabio Massari
Ariel Sánchez
María De La Vega
José Luis Mansur
Lucas Ricardo Brun


Osteoporosis and vertebral and non-vertebral fractures are common in glucocorticoid- m (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), and intra-articular and intramuscular GC administration on bone mineral density (BMD) and fragility fractures. 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, and prospective and retrospective studies comparing the effect of ESI, intra-articular or intramuscular GC used compared toa control group or baseline measurements were included. Results: A total of 8272 individuals were included among the 13 selected articles (10 about ESI and 3 about intra-articular GC; no article was found evaluating intramuscular GC). 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 surrogate outcomes. On the other hand, the qualitative analysis showed that most 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. In conclusion, there was insufficient evidence to suggest that ESI and intra-articular GC, unlike oral GC, negatively affect bone mass. Longitudinal studies are needed to obtain more knowledge regarding the effect of ESI or intra-articular GC on BMD and fragility fractures.

Detalles del artículo

Cómo citar
Brance ML, Chavero I, Ramírez 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. Efectos óseos de los glucocorticoides epidurales e intraarticulares: revisión sistemática de la literatura. Actual. Osteol. [Internet]. 8 de diciembre de 2023 [citado 22 de julio de 2024];19(2):144-59. Disponible en: https://ojs.osteologia.org.ar/ojs33010/index.php/osteologia/article/view/66


Habib GS, Saliba W, Nashashibi M. Local effects of intra-articular corticosteroids. Clin Rheumatol 2010;29(4):347-56.

Compston J. Glucocorticoid-induced osteoporosis: an update. Endocrine 2018;61(1):7-16.

Gado M, Baschant U, Hofbauer LC, Henneicke H. Bad to the Bone: The Effects of Therapeutic Glucocorticoids on Osteoblasts and Osteocytes. Front Endocrinol (Lausanne) 2022;13:835720.

Amiche MA, Albaum JM, Tadrous M, Pechlivanoglou P, Lévesque LE, Adachi JD, et al. Fracture Risk in Oral Glucocorticoid Users: A Bayesian Meta-Regression Leveraging Control Arms of Osteoporosis Clinical Trials. Osteoporosis Int 2016;27:1709-18.

Weitoft T, Rönnelid J, Knight A, Lysholm J, Saxne T, Larsson A. Outcome predictors of intra-articular glucocorticoid treatment for knee synovitis in patients with rheumatoid arthritis - a prospective cohort study. Arthritis Res Ther 2014;16(3):R129.

Jüni P, Hari R, Rutjes AW, et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev 2015;10:CD005328.

Johnston PC, Lansang MC, Chatterjee S, Kennedy L. Intra-articular glucocorticoid injections and their effect on hypothalamic-pituitary-adrenal (HPA)-axis function. Endocrine 2014;48(2),410-6.

Al-Shoha A, Rao DS, Schilling J, Peterson E, Mandel S. Effect of epidural steroid injection on bone mineral density and markers of bone turnover in postmenopausal women. Spine (Phila Pa 1976) 2012;37(25):E1567-71.

Stout A, Friedly J, Standaert CJ. Systemic Absorption and Side Effects of Locally Injected Glucocorticoids. PM R 2019;11(4):409-19.

Moher D, Shamseer L, Clarke M; PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4(1):1.

Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005;5:13.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;27(7414):557-60.

Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010;25(9):603-5.

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315(7109):629-34.

Dubois EF, Wagemans MF, Verdouw BC, et al. Lack of relationships between cumulative methylprednisolone dose and bone mineral density in healthy men and PM women with chronic low back pain. Clin Rheumatol 2003;22(1):12-7.

Kang SS, Hwang BM, Son H, Cheong IY, Lee SJ, Chung TY. Changes in bone mineral density in PM women treated with epidural steroid injections for lower back pain. Pain Physician 2012;15(3):229-36.

Yi Y, Hwang B, Son H, Cheong I. Low bone mineral density, but not epidural steroid injection, is associated with fracture in PM women with low back pain. Pain Physician 2012;15(6):441-9.

Mandel S, Schilling J, Peterson E, Rao DS, Sanders W. A retrospective analysis of vertebral body fractures following epidural steroid injections. J Bone Joint Surg Am 2013;95(11):961-4.

Kim S, Hwang B. Relationship between bone mineral density and the frequent administration of epidural steroid injections in PM women with low back pain. Pain Res Manag 2014;19(1):30-4.

Kim YU, Karm MH, Cheong Y, et al. Effect of Epidural Steroid Injection on Bone Mineral Density in PM Women According to Antiosteoporotic Medication Use. Pain Physician 2016;19(6):389-96.

Liu Y, Carrino JA, Dash AS, et al. Lower Spine Volumetric Bone Density in Patients with a History of Epidural Steroid Injections. J Clin Endocrinol Metab 2018;103(9):3405-10.

Nah SY, Lee JH, Lee JH. Effects of Epidural Steroid Injections on Bone Mineral Density and Bone Turnover Markers in Patients Taking Anti-Osteoporotic Medications. Pain Physician 2018;21(4);E435-E447.

Kim M, Yang YH, Son HJ, et al. Effect of medications and epidural steroid injections on fractures in PM women with osteoporosis. Medicine (Baltimore) 2019;98(26):e16080.

Haugeberg G, Morton S, Emery P, Conaghan PG. Effect of intra-articular corticosteroid injections and inflammation on periarticular and generalised bone loss in early rheumatoid arthritis. Ann Rheum Dis 2011;70(1):184-7.

Jensen TW, Hansen MS, Hørslev-Petersen K, et al; Cimestra study group. Periarticular and generalised bone loss in patients with early rheumatoid arthritis: influence of alendronate and intra-articular glucocorticoid treatment. Post hoc analyses from the CIMESTRA trial. Ann Rheum Dis 2014;73(6):1123-9.

Florance J, Hemke R, Chang CY, Torriani M, Bredella MA. Effects of intra-articular corticosteroid injections on lumbar trabecular density. Skeletal Radiol 2020;49(5):787-93.

Artículos más leídos del mismo autor/a

<< < 1 2 3 4 5 6 7 8 9 10 > >>