Ok for steroid injections and osteoporosis

[lobelsteve]

Corticosteroid Injections and Risk of Fracture

This cohort study assesses whether cumulative doses of corticosteroid injections are associated with risk of fracture in adults.

jamanetwork.com

Cohort study
N 7000+

Meh

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[PinchandBurn]

It appears benefits outweigh risk.

Clinically makes sense to inject so patients are more mobile so they don't stay immobile and progress with osteoporosis..

 

[drusso]

Corticosteroid Injections and Risk of Fracture

This cohort study assesses whether cumulative doses of corticosteroid injections are associated with risk of fracture in adults.

jamanetwork.com

Cohort study
N 7000+

Meh

I suspected this all the time.

 

[Agast]

Benefits for hydrocodone 5 twice a day probably outweighs the risks for osteoporosis grandma who can’t have joint replacement surgery, but ain’t nobody going to make a study about that.

 

[gaspasser127]

How many steroid exposures per year is too many?

I prefer no more than 4-5…

 

[Ducttape]

one concern is that the time frame, while the study considers long, is only 4 years.

i would be interested in a 50-year-old getting multiple injections and whether that significantly changed risk for osteoporotic fracture when they are 70.

Benefits for hydrocodone 5 twice a day probably outweighs the risks for osteoporosis grandma who can’t have joint replacement surgery, but ain’t nobody going to make a study about that.

(if you are talking about traumatic fractures, i believe the standard of care is to operate on all of them.)

otoh, this:

An updated analysis of opioids increasing the risk of fractures

Objective To assess the relationship between opioid therapy for chronic noncancer pain and fracture risk by a meta-analysis of cohort studies and case-control studies. Methods The included cohort studies and case-control studies were identified by searching the PubMed and EMBASE databases from...

journals.plos.org

Main analysis​

There was a positive correlation between the use of opioids and fractures (RR 1.78, 95% CI 1.53–2.07) (Fig 2), and we observed significant heterogeneity among the studies. Eleven studies provided data on opioid use and hip fracture risk [3,7,19–23,27,29–31]. Pooled studies showed that the use of opioids had a significant impact on the risk of hip fracture (RR 1.56, 95% CI 1.37–1.79

Previously, the most recent meta-analysis (Ping et al. [33]) was limited to the study of hip fractures, and Grewal et al. [9] showed that patients taking opioids had a risk of fracture after discharge compared with patients who were not taking opioids. The main reason for the increase was that patients taking opioids were prone to vertigo and falls that can lead to fractures. In addition, Aspinall's et al. [6] study showed that patients receiving opioid therapy had an increased risk of falls, and the accompanying final outcomes were fractures [6]. Schwarzer et al's [8] study also suggested that when opioid use was considered, the risk of fractures increased [8].

In addition, there are two main mechanisms for the occurrence of fractures with opioid use. One mechanism is that opioids may reduce bone density by inhibiting the production of endogenous sex hormones, leading to an increased risk of fractures [34]; the other mechanism involves the side effects of opioids, such as the central nervous system side effects of vertigo, fatigue, etc., that lead to the occurrence of fractures [7,9,27,28], and there is a high incidence of side effects, including acute cognitive deterioration, increased sputum production, decreased oxygen saturation, and constipation, after the use of opioids in elderly populations

 

[interjectionreflection]

How many steroid exposures per year is too many?

I prefer no more than 4-5…

One of the people I trained with did no more than 3 per site per year. So for example if someone were getting cervical and lumbar epidural/facet etc it would be 3 in each site (6 total) samething if they have peripheral joint steroids and epidurals etc

I don't know any studies around this though just anecdotal from that staff then there were other staff that did 3-4 max all sites included per year

 

[lobelsteve]

One of the people I trained with did no more than 3 per site per year. So for example if someone were getting cervical and lumbar epidural/facet etc it would be 3 in each site (6 total) samething if they have peripheral joint steroids and epidurals etc

I don't know any studies around this though just anecdotal from that staff then there were other staff that did 3-4 max all sites included per year

Corticosteroid Injections and Risk of Fracture

This cohort study assesses whether cumulative doses of corticosteroid injections are associated with risk of fracture in adults.

jamanetwork.com

 

[Dr. Ice]

One of the people I trained with did no more than 3 per site per year. So for example if someone were getting cervical and lumbar epidural/facet etc it would be 3 in each site (6 total) samething if they have peripheral joint steroids and epidurals etc

I don't know any studies around this though just anecdotal from that staff then there were other staff that did 3-4 max all sites included per year

Why is the magic number 3 so pervasive in pain medicine, so much so that insurance companies have adopted the dogma. Can anyone site real literature on why 3? If there is no current standard of care as to how much steroid can be of detriment, why stick to 3? My PA blue insurances will not allow a repeat epidural for 3 months after the first one without any rhyme or reason other than the magic number 3.

 

[SSdoc33]

Why is the magic number 3 so pervasive in pain medicine, so much so that insurance companies have adopted the dogma. Can anyone site real literature on why 3? If there is no current standard of care as to how much steroid can be of detriment, why stick to 3? My PA blue insurances will not allow a repeat epidural for 3 months after the first one without any rhyme or reason other than the magic number 3.

skip to 1:30. five is right out

 

[clubdeac]

Benefits for hydrocodone 5 twice a day probably outweighs the risks for osteoporosis grandma who can’t have joint replacement surgery, but ain’t nobody going to make a study about that.

Argument could be made that the added fall risk with Vicodin in an already osteoporotic patient likely outweighs any potential subjective benefit

 

[lobelsteve]

Argument could be made that the added fall risk with Vicodin in an already osteoporotic patient likely outweighs any potential subjective benefit

OR 1.6 pooled with strong and weak opioids. Worse with higher MME. oddly, untreated pain increases fall risk.