Abstract

Purpose

To determine the effect of intra-articular corticosteroid injections on lumbar spine trabecular density.

Materials and methods

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.

Results

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).

Conclusion

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.

中文翻译：

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关节内激素注射对腰椎小梁密度的影响

摘要

目的

为了确定关节内注射皮质类固醇激素对腰椎小梁密度的影响。

材料和方法

这项回顾性研究经IRB批准且符合HIPAA。我们确定了50例患者（26 F，24 M，平均年龄69±14岁），他们在第一次注射后的5年内至少接受了三次中等剂量或大剂量的联合皮质类固醇激素注射，使用不溶性皮质类固醇激素，随后进行了无造影剂腹部CT扫描。确定了大约126名年龄和性别匹配的对照，这些对照没有接受过先前的皮质类固醇激素使用史，并且接受了非对比腹部CT检查。计算了皮质类固醇的累积剂量。对L1到L4的小梁骨进行密度测量（HU），并将L1的测量值与建立的标准数据进行比较。使用双面配对t检验或卡方检验比较各组。累积糖皮质激素剂量和骨小梁密度之间进行线性回归分析。

结果

患者平均接受了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±100 mg曲安西龙（范围120 mg至480 mg）。病例与对照之间，L1至L4的骨小梁密度无显着差异，与标准数据相比，L1的骨小梁密度无显着差异（p  > 0.2）。关节内糖皮质激素的累积剂量与平均腰椎小梁密度之间无关联（p  > 0.3）。

结论

与对照组相比，接受反复关节内不溶性皮质类固醇注射的患者没有出现骨质流失的风险增加。关节内糖皮质激素的累积剂量与腰椎小梁密度无关。