Original Investigation
Geriatrics
May 31, 2024
Corticosteroid Injections and Risk of Fracture
Terin T. Sytsma, Shannon Thomas; Karen M. Fischer, et al
JAMA Netw Open. 2024;7(5):e2414316. doi:10.1001/jamanetworkopen.2024.14316
Question Are high numbers of corticosteroid injections (CSIs) associated with subsequent fractures?
Findings In this cohort study of 7197 patients over a 4-year period, higher fracture risk was not associated with the cumulative dose of injected corticosteroid, regardless of osteoporosis status.
Meaning Corticosteroid injections are an important option for pain treatment, and clinicians should not withhold CSI owing to fear of fracture risk.
Abstract
Importance Corticosteroid injections (CSIs) are an important tool for pain relief in many musculoskeletal conditions, but the longitudinal effects of these treatments on bone health and fracture risk are unknown.
Objective To determine whether cumulative doses of corticosteroid injections are associated with higher risk of subsequent osteoporotic and nonosteoporotic fractures.
Design, Setting, and Participants This cohort study included adult patients receiving any CSI from May 1, 2018, through July 1, 2022. Eligible patients resided in Olmsted County, Minnesota, and were empaneled to receive primary care within the Mayo Clinic. Cox proportional hazards regression models were used to evaluate risk of fracture based on cumulative injected corticosteroid dose.
Exposure Receipt of any CSI during the study period.
Main Outcomes and Measures The primary outcome was risk of fracture by total triamcinolone equivalents received. Secondary outcomes consisted of risks of fracture based on triamcinolone equivalents received in subgroups of patients not at high risk for fracture and patients with osteoporosis.
Results A total of 7197 patients were included in the study (mean [SD] age, 64.4 [14.6] years; 4435 [61.6%] women; 183 [2.5%] Black and 6667 [92.6%] White), and 346 (4.8%) had a new fracture during the study period. Of these fractures, 149 (43.1%) were considered osteoporotic. In the adjusted Cox proportional hazards regression model, there was no association of higher fracture risk based on cumulative CSI dose (adjusted hazard ratio [HR], 1.04 [95% CI, 0.96-1.11]). There was also no associated higher risk of fracture in the non–high-risk (adjusted HR, 1.11 [95% CI, 0.98-1.26]) or osteoporosis (adjusted HR, 1.01 [95% CI, 0.90-1.11]) subgroups. Age, Charleson Comorbidity Index, and previous fracture were the only factors that were associated with higher fracture risk.
Conclusions and Relevance In this cohort study of cumulative injected corticosteroid dose and risk of subsequent fracture, no association was observed, including in patients with a preexisting diagnosis of osteoporosis. Treatment of painful conditions with CSI should not be withheld or delayed owing to concern about fracture risk.
