Most people are aware that long term use of steroids is bad for the bones and can lead to osteoporosis. But what about short term use? What about use for a year? A day?
Steroids are used to control inflammation. Our body produces its own cortisol (as opposed to the synthetic cortisone), but this is under very tight regulation with feedback loops. Of course, with poor lifestyle changes and chronic stress this balance can get disrupted and create dysfunction.
This particular study gives us a better idea of just how little it can take to begin to destroy our bones with the use of steroids to control inflammation. Long term use of steroids is typical in many conditions such as lupus and rheumatoid arthritis. Short term use is also used far too common in musculoskeletal complaints like shoulder, neck and low back pain.
It is established the the risk for osteonecrosis in long term (>1 year) use of steroids increased the risk an incredibly massive 212,200 times (OR 212.2). I have personally never seen an odds ratio this high before. To put this in some degree of perspective, one would have to smoke maybe 20 packs of cigarettes through a hole directly in the trachea for 100 years to increase your risk this much for lung cancer.
While this study focused on the use of steroids for lupus and RA, we can begin to see how short term use of steroids for musculoskeletal conditions are largely inappropriate.
The risk of osteonecrosis was quite striking and most often affected the hip. Researchers identified some very interesting trends. The first set of items they looked at was how long ago someone who experienced bone death was exposed to steroids. Oral, injected or IV did not appear to be different. In other words, you took a course of steroids for low back pain last week—how much did this affect you vs taking a course 3 years earlier….
- Use ONE day to 90 days ago risk was increased 580%
- ½ year to 1 year increased 890%
- More than 2 years earlier 430%
Can we begin to see that routine use of steroids (for conditions that would very likely respond well to chiropractic care) can increase the risk for serious long term consequence even years later?
So, while my opinion as a chiropractor is clearly biased, the decision to use a non-drug effective alternative to any musculoskeletal complaint continues to be strongly supported by the medical literature.