Corticosteroid Injections and Risk of Fracture

Area of Science:

• Musculoskeletal Health
• Bone Metabolism
• Pharmacology

Background:

• Corticosteroid injections (CSIs) are widely used for musculoskeletal pain relief.
• Longitudinal effects of CSIs on bone health and fracture risk remain unclear.

Purpose of the Study:

• To investigate the association between cumulative corticosteroid injection doses and subsequent fracture risk.
• To assess fracture risk in patients with and without osteoporosis receiving CSIs.

Main Methods:

• A cohort study of 7197 adult patients receiving CSIs between May 2018 and July 2022.
• Cox proportional hazards regression models analyzed fracture risk based on cumulative CSI dose (triamcinolone equivalents).
• Subgroup analyses included patients not at high risk for fracture and those with osteoporosis.

Main Results:

• No association was found between higher cumulative CSI dose and increased fracture risk (adjusted HR, 1.04).
• This lack of association held true for subgroups of patients not at high risk (adjusted HR, 1.11) and those with osteoporosis (adjusted HR, 1.01).
• Age, Charlson Comorbidity Index, and prior fracture were significant risk factors for fracture.

Conclusions:

• Cumulative corticosteroid injection dose is not associated with an increased risk of subsequent fractures.
• CSI treatment for painful conditions can proceed without undue concern for fracture risk, even in patients with osteoporosis.
• Clinical decisions regarding CSI should not be deterred by potential fracture risks.