Bone loss occurs most rapidly in the first 6 months after starting oral steroid medication. After 12 months of chronic steroid use, there is a slower loss of bone. Some people are concerned about the eects of inhaled steroids. Inhaled steroids are less likely to cause bone loss than steroids taken by mouth. However, in higher doses, inhaled steroids may also cause bone loss. Steroid medications used for only a few days or applied to the skin are not associated with bone loss. The major impact of steroid medications on bone is fractures (broken bones) that occur most commonly in the spine and ribs. Steroid medications (taken by mouth) equal to or more than 5mg of prednisone daily, taken for more than 3 months, is considered a risk for fracture. Fracture risk increases as the daily doses of steroid medications increase. Almost 1 in 3 postmenopausal women who routinely take steroid medications will have a spine fracture. A person on steroids is more than twice as likely to have a spine fracture compared to a person not taking steroids. Your health care provider determines when you should stop taking your steroid medication. Once the medication is stopped, it is expected that your fracture risk will lessen. You should never change the way you take your medication until you speak to your health care provider.
Epidural steroid injections are generally very safe, but there are some rare potential complications. One of the most common risks is for the needle to go too deep and cause a hole in the dura, the tissue that surrounds the spinal cord and nerve roots. When this occurs spinal fluid can leak out through the hole and cause a headache . This headache can be treated with bedrest, or with a blood patch. A blood patch involves drawing some blood from the vein and the injecting it over the hole in the dura. The blood forms a seal over the hole and prevents any further fluid from leaking out.
The lesion depicted in Figure A is unicameral bone cyst (UBC), a benign tumor typically seen in the ends of long bones(Illustration A) in the skeletally immature. UBCs can also occur in the tarsal bones of the foot. The cyst usually progressively shrinks as the patient approaches skeletal maturity and may heal spontaneously after growth is completed.
Smith and Smith reviewed 20 cases of pediatric calcaneal UBCs over 20 years. Half were treated operatively with curretage and bone grafting. The non-operative group did well and after 20 years most of the UBCs healed completely. Those that didn't heal did not progress.