Effects of intra-articular corticosteroid injections on lumbar trabecular density
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SCIENTIFIC ARTICLE
Effects of intra-articular corticosteroid injections on lumbar trabecular density Jonathon Florance 1 & Robert Hemke 1,2 & Connie Y. Chang 1 & Martin Torriani 1 & Miriam A. Bredella 1
Received: 14 October 2019 / Revised: 27 November 2019 / Accepted: 5 December 2019 # ISS 2019
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. Keywords Intra-articular corticosteroid injection . Computed tomography (CT) . Opportunistic CT . Lumbar spine . Trabecular density
Introduction Osteoarthritis is the most common cause of disability in older adults affecting over 50 million Americans [1]. Osteoarthritis has been recognized as an inflammatory condition with synovitis accompanied by accumulation of mononuclear cells and release of proinflammatory cytokines [2], and intra-articular
* Miriam A. Bredella [email protected] 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
2
Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences (AMS), Meibergdreef 9, 1105 Amsterdam, AZ, Netherlands
inflammation is associated with pain and progression of cartilage damage [3, 4]. Corticosteroids have anti-inflammatory and immuno
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