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Pain and Spine Medicine

Risk of Lumbar Fracture Following Epidural Steroid Injection in Osteoporotic versus Non-Osteoporotic Patients

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Original Research Theater

    Co-Author(s)

  • Nafis Eghrari, Other

    Medical Student
    Case Western Reserve University School of Medicine
    Cleveland, Ohio

    • Poster Presenter(s)

  • Bryan Yavari, Other

    Medical Student
    University of Arizona College of Medicine - Phoenix
    Scottsdale, Arizona

    • Co-Author(s)

  • Chong Kim, MD

    Professor
    MetroHealth/Case Western Reserve University
    Westlake, Ohio

Disclosure(s):
Nafis Eghrari, Other: No financial relationships to disclose
Chong Kim, MD: No financial relationships to disclose
Background and/or Objectives: Lumbar epidural steroid injections (ESIs) are commonly used to treat radicular lumbar pain. Some studies have suggested that ESIs may reduce bone mineral density and lead to osteoporotic fractures, however, this association is poorly understood and has not been examined on a macro level.

Design: Retrospective cohort study

Setting : National database

Participants : TriNetX, a national research network of de-identified patient records, was retrospectively queried. We identified all patients who underwent their first-ever epidural steroid injection and then stratified them into two groups based on osteoporotic status.

Interventions: Not applicable

Main Outcome Measures: Incidence of lumbar fracture and falls within five years of epidural steroid injection.

Results: 106,047 total patients were included in our analysis, with 11,600 included following PSM. Following ESI, osteoporotic patients were more likely to experience lumbar fracture (OR: 1.89; 95% CI: 1.54–2.31), fall (OR: 1.15; 95% CI: 1.02–1.30), decreased mobility (OR: 1.32; 95% CI: 1.20–1.45), and loss of independence (OR: 1.33; 95% CI: 1.10–1.60) compared to non-osteoporotic patients. Osteoporosis did not impact risk of lumbar fracture or falls for male patients of any age and non-elderly ( < 65 years) patients, although it did increase lumbar fracture risk in females (OR: 2.07; 95% CI: 1.63–2.62) and elderly (>65 years) patients (OR: 1.66; 95% CI: 1.34–2.06).

Conclusions: Lumbar ESI does not predispose male and non-elderly patients with osteoporosis to lumbar fracture or falls. However, elderly females with osteoporosis are more likely to experience lumbar fracture or falls following lumbar ESI. Osteoporotic lumbar fracture risk following lumbar ESI is dependent on age and gender, and physicians should account for demographics when considering ESI for back pain in patients with osteoporosis.