Epidural steroid injections and fracture incidence among older individuals with radiculopathy
Authors' conclusion
ESI exposure in older individuals is associated with an increased risk of fracture, suggesting there may be lasting detrimental skeletal effects of ESI.
Study context
- Population
- Individuals with radicular pain, 2005–2018 5% Medicare data; mean age 76 yr, 74% femaleExposure density sampling (EDS)-matched
- Participants
- 25,062 vs 221,735
- Exposure
- ESI vs no ESI
- ESIn = 25,062
- non-ESIn = 221,735reference
- Outcome
- Incidence of osteoporotic fractures, and specifically vertebral fractures
Methodological detailsexposure density sampling matched 1:10 by age, sex and month of radicular pain diagnosis, high-dimensional propensity score matched 1:1
- Exposure density sampling matched 1:10 by age, sex and month of radicular pain diagnosis
- High-dimensional propensity score matched 1:1
Main finding
As reported in the abstract
Fracture incidence and hazard at typical osteoporotic sites
ESI
49.1
2296 of 25 062
non-ESI
35.2
11 917 of 221 735
ESI vs non-ESIHazard ratio (95% CI)
EDS
1.39(1.33–1.46)
HDPS
1.32(1.12–1.54)
Observational data: associations, not effects.
Further findings
| Outcome | HR (CI) | |
|---|---|---|
| Vertebral fractureESIvs non-ESIEDS | 1.54 (1.45–1.64) | |
| Vertebral fractureESIvs non-ESIHDPS | 1.69 (1.38–2.07) | |
| 0.512Hazard ratio (log scale) |
Fractures by cumulative ESI dose · first 6 mo of follow-up
- Greater cumulative ESI doses (≥3 in 1 yr) had higher fracture risk within first 6 mo
Original publication
Epidural steroid injections and fracture incidence among older individuals with radiculopathy. J Bone Miner Res. Published 30 September 2024. doi:10.
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