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Effects of intra-articular corticosteroid injections on lumbar trabecular density

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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.

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Funding

This study was supported by NIH grants K24DK109940 and P30DK040561.

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Authors and Affiliations

  1. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA

    Jonathon Florance, Robert Hemke, Connie Y. Chang, Martin Torriani & Miriam A. Bredella

  2. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences (AMS), Meibergdreef 9, 1105, Amsterdam, AZ, Netherlands

    Robert Hemke

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  1. Jonathon Florance
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Contributions

All authors made substantial contributions to the (1) conception and design or acquisition of data or analysis and interpretation of data, (2) drafting of the article or revising it critically for important intellectual content, and (3) final approval of the version to be published and (4) agree to be accountable for all aspects of the work if questions arise related to its accuracy or integrity.

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Correspondence to Miriam A. Bredella.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was waived for this retrospective study.

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Florance, J., Hemke, R., Chang, C.Y. et al. Effects of intra-articular corticosteroid injections on lumbar trabecular density. Skeletal Radiol 49, 787–793 (2020). https://doi.org/10.1007/s00256-019-03362-2

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  • DOI: https://doi.org/10.1007/s00256-019-03362-2

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