Patient is a mid 60s tall thin women whom I have been treating for her bone loss since 2015. Her T scores were mid negative 3's. Yearly or q 2 year DXAs improved for the first 4 years when patient was more regular in her supplements and HRT. As of 2020 the lumbar spine T score was the same as 2015 measuring -3.7 both years. The hips as of 2022 are the same as in 2015 and stable since 2020 (mid 3s). The wrist is stable and mid ones.
Of note is between 2020 and 2022 the DEXA just performed revealed the L-spine dropped from -3.7 to -5.1!!! (this is severe osteoporosis) Note again that the hips bilaterally and wrist were stable. Questioning the patient I learned that she received only two epidural steroid injections in the lumbar area for some discogenic pain by an Orthopod. No other doctor had a clue why she lost so much bone in Lumbar area so quickly. Prolia injections were recommended.
There are studies discussing the loss of bone that is possible with epidural steroid injection that were easily found when I was talking to the patient. Of course there was zero informed consent given to the patient regarding localized bone loss from the injections.
The patient complains of the feeling of extreme weakness in her lumbar spine and pain. No doubt that all lower spine supportive connective tissues have experienced similar atrophy and softening in this thin fragile tall female by the injection of the 'catabolic' steroids into her spine.
More on the overuse of the often harmful corticosteroid class of meds can be found here:
OVERUSE OF CORTICOSTEROIDS ('Steroids') LIKE PREDNISONE
Conclusions: ESIs should be recommended with caution, especially in patients at risk for osteoporotic fractures, such as women of postmenopausal age. Anti-osteoporotic medication might be considered prior to ESI.