Postmenopausal Women Treated With Steroid Injection For Back Pain At Significant Risk For Bone Loss

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Main Category: Bones / Orthopedics
Also Included In: Menopause;  Back Pain
Article Date: 04 Dec 2012 - 1:00 PST Current ratings for:
Postmenopausal Women Treated With Steroid Injection For Back Pain At Significant Risk For Bone Loss

Postmenopausal women suffered significant bone density loss in their hip after they were treated with an epidural steroid injection for back pain relief, according to a Henry Ford Hospital study

Bone density loss after six months was six times greater when compared to the typical bone density loss seen in a year in a postmenopausal woman who doesn't receive steroid injection, researchers say.

Shlomo Mandel, M.D., a Henry Ford orthopedic physician and the study's lead author, says physicians should exercise caution prescribing an epidural steroid for select patients, suggesting that multiple injections may compromise bone strength.

"The findings of our study suggest that epidural steroid injections for back pain relief should be approached cautiously in patients at risk for bone fragility," Dr. Mandel says. "Physicians who do prescribe them should consider measures that optimize bone health such as calcium and vitamin D supplements and exercise as part of their patient's treatment plan.

The study was published in Spine.

Back pain is one of the most common medical conditions in the United States, affecting 8 out of 10 people at some point during their lives. As people age, their spine ages with them, causing degenerative changes in the spine.

Patients are typically treated with anti-inflammatory drugs and physical therapy. If symptoms persist, an epidural steroid is often prescribed to alleviate pain and improve function. However, steroid use has been linked to diminished bone quality.

In the observational study, Henry Ford sought to evaluate whether steroid injections used for treating lumbar stenosis, increased the risk of bone loss in postmenopausal women. Lumbar stenosis is an abnormal narrowing of the spine canal. Twenty-eight patients, aged 65 and older and treated between 2007-2010, were evaluated for bone loss using bone density testing and serum biochemical markers prior to receiving an injection, then at three- and six-month intervals.

The bone loss data was compared to bone loss data for postmenopausal women who hadn't been treated with an epidural injection.

"Patients receiving multiple steroid injections with a history of steroid exposure may be especially susceptible to compromised bone strength," Dr. Mandel says.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our bones / orthopedics section for the latest news on this subject. The study was funded by Henry Ford Hospital.
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Low Back and Pelvic Pain Treated Nonsurgically with Progressive Resistance Exercise

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Low back and pelvic pain is common. The spinal column connects the low back (lumbar spine) to the pelvis, also called the pelvic girdle. Both the lumbar spine and pelvic girdle support a great amount of the body's weight. Although low back and pelvic girdle pain is often associated with pregnancy, simple disorders such as muscle strain to more serious injuries can cause this pain.

The purpose of this article is to introduce you to progressive resistance exercise to treat low back and pelvic girdle pain. Progressive resistance exercise helps patients reach their rehabilitation goals. Such exercise works by gradually challenging the muscles to strengthen. Measuring the patient's progress from the start of a program and throughout is a key part of rehab success. Rehabilitation specialists around the world favor progressive resistance exercise, which is supported by research and good patient outcomes.

The Difference: Measuring Patient Progress
Critical to the success of an exercise program is the ability to objectively measure the patient's progress. In fact, experts say measuring function is a more reliable barometer of the patient's progress than measuring their pain! You might find it interesting to learn that not all types of exercise equipment accurately measure a patient's progress during progressive resistance exercise. This measurement concept and its importance were recognized by two innovative leaders in the field of progressive resistance exercise.

Exercise Equipment's Evolution
The idea of exercise equipment is not new. In 1865, a Swedish physician (Dr. Gustav Zander) developed mechanical therapy, which allowed progress to be measured. Doctor Zander developed 40 pieces of equipment that isolated specific joint functions. Plus the amount of resistance could be changed.

Soon, in facilities around the world, exercise equipment started to be laid out in a circuit. This allowed patients to move from one machine to the next; similar to health clubs today. Although popular, the medical community did not accept the exercise machines as having therapeutic benefits.

Efficient exercise really got on track when Arthur Jones created "Nautilus Exercise Equipment" first sold during the 1970s. His equipment revolutionized exercise and health maintenance by appealing to both men and women. Mr. Jones discovered the use of a cam to spread peak resistance throughout the entire arc of a joint's range. This exercise equipment started the whole health club industry.

Soon Nautilus had competition as Cybex entered the marketplace. The difference was Cybex was marketed to the medical community and reported on in medical journals. Cybex differed from Nautilus in that it was based on isokinetics. Isokinetic exercise is a type of active-resistive exercise with a rate-limiting device to control the speed of movement. The term isokinetic means movement occurs at a constant and equal speed. Despite Cybex's ability to produce computerized graphics displaying joint function, its clinical use was not widespread.

Arthur Jones Returns
MedX™ (Core Spinal Fitness Systems™ by MedX™) is a specific type of exercise equipment developed by Arthur Jones to treat chronic back problems. It uses isometric testing to measure spinal strength. The term isometric means static exercise, that is, without movement. MedX™ is widely used today.

MedX™ is unique in its capability to isolate the lumbar extensor muscles and force other muscles into action; such as the multifidus and erector spinae.

The extensor muscles assist in extending the spine. The multifidus is a series of paired small muscles that extend the entire length of the spine. These muscles help to stabilize, extend and rotate the spine. The erector spinae is the largest muscle mass in the back and assists in spinal flexion and stabilization.

The muscles are worked in the eccentric and concentric modes. This means the muscle lengthens, develops tension and contracts to control resistance (eccentric); and shortens, develops tension and contracts against resistance (concentric).

Why Progressive Resistance Exercise is Important
Studies show that patients with chronic back pain have weaker extensor muscles (the muscles that extend and help stabilize the spine) than patients without back pain. Also, MRI studies have shed new light onto the muscular changes that occur with chronic back pain. For example, the multifidus musculature is smaller and fattier in chronic back pain patients compared with people without chronic back pain. How does this happen? Many chronic back pain patients find exercise difficult and this can cause muscle atrophy (deterioration). Why is atrophy an important consideration? Because when the multifidus is smaller, it affects the spine's capacity to stabilize the torso.

Other studies prove muscle size and function can be improved. For example, EMG studies show that with exercise the lumbar extensors (muscles that assist the low back) can be strengthened thus improving function. Researchers at the Physical Therapy Department at Queensland University of Australia used ultrasound and fine wire electrodes to evaluate muscle size and function in real time. The outcome made it clear that spinal muscles, including the multifidus, work to stabilize the torso. Therefore, it is reasonable to conclude that exercise (progressive resistance exercise) offers therapeutic benefits.

Why Progressive Resistance Exercise?
Progressive resistance exercise helps to strengthen low back muscles, reduce low back and pelvic pain, and is appropriate. Many studies prove this statement. One study reported that patients involved in a program of progressive resistance exercise had a 30% recurrence rate of back pain compared with 80% of patients who did not exercise.

MedX™ equipment, such as the MedX™ Lumbar Strengthening System (Core Spinal Fitness Systems™) enables the rehabilitation specialist to measure the patient's performance from baseline through training progression. Not only are repetitions tracked but resistance is monitored. MedX™ is the type of equipment sports teams, golfers and other athletes use. Undoubtedly, if there was a better way for professional athletes to exercise or rehabilitate, everyone would be reading about it!

Source:
Mooney, V. Effective Rehabilitation of Lumbar and Pelvic Girdle Pain. Movement, Stability and Lumbopelvic Pain. (Ed. Vleeming, Stockart and Mooney). To be published by Elsevier Science (2007).