News Steroid injection linked to increased risk of bone fractures
Patients treated with an epidural steroid in- jection for back pain relief are at increased risk of bone fractures in the spine, according to a Henry Ford Hospital study. Researchers say the risk of fracture in- creased 29 percent with each steroid injec- tion, a finding they believe raises patient safety concerns. “For a patient population already at risk for bone fractures, steroid injections carry a greater risk that previously thought and actu- ally pose a hazard to the bone,” says Shlomo Mandel, M.D., a Henry Ford orthopedic phy- sician and the study’s lead author. Dr. Mandel recommends that patients be- ing treated with steroid injections be told
about the risks associated with future frac- tures and undergo bone testing.
The study was accepted as a Best Paper to be presented Thursday, Oct. 25 at the an- nual meeting of the North American Spine Society in Dallas.
Bone fractures in the spine are the most common fracture in patients with osteopo- rosis, affecting an estimated 750,000 people annually. Roughly 40 percent of women aged 80 and older experience bone fractures in the spine.
Patients are typically treated with anti- inflammatory drugs and physical therapy. If symptoms persist, an epidural steroid is of- ten prescribed to alleviate pain and improve
function. However, steroid use has been linked to diminished bone quality. In a retrospective study, researchers com- pared data of 6,000 patients treated for back pain between 2007 and 2010 – 3,000 patients who received at least one steroid injection and 3,000 patients who did not receive in- jection. The average age of patients was 66 years, and 3,840 were women and 2,160 were men. Researchers also analyzed the incidence of bone fractures in each group. Using the survival analysis technique, re- searchers found that the number of steroid injections is linked with an increased likeli- hood of fracture.
Computerised osteoporosis detection
A computerised approach to examining pa- tient bone X-rays for diagnosis of osteoporo- sis could side-step the subjectivity associated with visual examination, according to a new research paper in the International Journal of Biomedical Engineering and Technology published in October.
Neelesh Kumar of the Central Scientific Instruments Organisation in Chandigarh, India, and colleagues recognised that the bone disorder osteoporosis is on the in- crease but that diagnosis using X-ray im- ages of the patient’s skeleton often lead to false positives and false negatives because visual examination, no matter how expert, is subjective. They have now developed a new approach based on the digitisation of the X-ray images and estimation of the bone porosity associated with osteoporosis based on a sophisticated computer algorithm. X- rays are used in four times out of five for the diagnosis of osteoporosis, usually where other more expensive or inconvenient tests such as dual X-ray absorptiometry (DXA) are precluded. The World Health Organisation (WHO)
defines osteoporosis as “a skeletal disorder characterised by compromised bone strength predisposing a person to an increased risk of fracture”. X-ray examination usually confirms the diagnosis at the severe or late-stage of development. However, a computerised sys- tem could allow much earlier diagnosis to be
8 | SpinalSurgeryNews | Autumn 2012
made and so give patients the opportunity to be treated more successfully before the disorder becomes a potentially debilitating illness. The addition of a reference index to the X-ray image is key to the success of the new computerised technique. In conventional methods, the X-ray source quality, the film and its processing quality are possible sources of error but in the new system these sources are all but removed by the digital index on the film, the team says.
The team has tested the system on 40 el-
derly Asian patients with known diagnoses. 9 out of 10 of the females had osteoporosis, almost two-thirds of the men. The error rate is less than 2 percent, the team says. The team has begun the compilation of a knowledge base contained validated X-ray images to
which the computer algorithm compares new X-rays. This database can be added to with new verified images once a definitive diag- nosis has been made and so the system will improve with use.
“The new tool is a cost-effective solution, as it uses the existing facilities available in hospitals and thus, imparts no extra financial burden on healthcare providers or patients for quantitative estimation of osteoporosis,” the researchers say. They point out that the same computerised diagnosis could be adapted to analyse bone deformity, scoliosis measure- ment, X-ray cracks and fractures.
“Computer aided diagnostic tool for osteopo- rosis estimation” in Int. J. Biomedical Engi- neering and Technology, 2012, 9, 316-324
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