1. 2025;28;E183-E189Influence of Lumbar Epidural Steroid Injection on Osteoporosis and Denosumab Treatment
   Retrospective Analysis
   Jun-Han Kim, MD, Jeong-mo Koo, MD, Dong-Eun Shin, MD, and Tae-Keun Ahn, MD.

BACKGROUND: Lumbar epidural steroid injections (ESIs) are commonly used to alleviate pain associated with lumbar disorders. However, administering steroids to patients with osteoporosis may lead to a decline in bone mineral density (BMD) and increase fracture risk. While various steroids are utilized in ESIs, limited research exists on their effect on BMD.

OBJECTIVES: This study aimed to analyze the effect of dexamethasone-based ESI therapy on osteoporosis in patients receiving or not receiving denosumab, utilizing real-world clinical data.

STUDY DESIGN: Retrospective analysis.

SETTING: A university hospital orthopedic department.

METHODS: A retrospective review was conducted, incorporating patients who underwent denosumab therapy alongside ESIs for pain alleviation from January 2018 through April 2022. Eligibility criteria included patients with a minimum follow-up period of 12 months. Forty patients who had received an ESI and denosumab treatment were enrolled in Group One. Similarly, 35 patients who had only received an ESI (Group 2) and 33 patients who underwent denosumab treatment alone (Group 3) were enrolled and analyzed. Statistical analysis was performed using analysis of variance (ANOVA) to compare patient age, gender, lumbar and  hip BMD, difference in lumbar and hip BMD at postinjection one year, serum vitamin D, calcium, phosphorus levels, and one-year cumulative steroid dosage.

RESULTS: In terms of patient demographics, the mean age of Group One was 71.73 (± 9.59) years, Group 2 was 70.00 (± 9.82) years, and Group 3 was 71.18 (± 5.64) years. The ANOVA analysis revealed no significant differences among groups. The BMD analysis showed that the lumbar BMD in Group One was 0.811 g/cm2, Group 2 was 0.831 g/cm2, and Group 3 was 0.822 g/cm2. Hip BMD in Group One was 0.696 g/cm2, Group 2 was 0.711 g/cm2, and Group 3 was 0.668 g/cm2. The change in BMD values showed that in Group One, lumbar BMD increased by 0.0411 g/cm2 compared to baseline, a 5.06% increase, while hip BMD increased by 0.0047 g/cm2, a 0.68% increase. In Group 2, lumbar BMD decreased by -0.0307 g/cm2, a 3.7% decrease, and hip BMD decreased by -0.036 g/cm2, a 5.02% decrease. In Group 3, lumbar BMD increased by 0.056 g/cm2, a 6.77% increase, while hip BMD increased by 0.005 g/cm2, a 0.69% increase.

LIMITATIONS: The number of patients recruited was relatively small and limited to specific age groups. Study design was retrospective.

CONCLUSION: Lumbar ESIs with dexamethasone reduce BMD in elderly patients with osteoporosis. However, when denosumab is administered alongside dexamethasone-based ESIs, the steroid does not significantly affect the decline of BMD.

KEY WORDS: Steroid, epidural injection, osteoporosis, antiresorptive agent, denosumab, bone mineral density, lumbar spine