What’s new in epidural steroid complications? I’ve often discussed that epidural steroids have a very powerful hit of anti-inflammatory steroids. How powerful? I like to explain to patients that if the height of a matchbook represents the amount of steroid your body naturally produces, the height of the Empire State Building represents the amount in a traditional epidural steroid shot. Complications from epidural steroid injections in women have been widely reported this past few months with a 29% increase in fracture risk per injection. This is likely happening because each shot has a massive amount of steroid medication that inhibits bone stem cells from maintaining bone, likely hitting a significant fraction of them hard with each exposure. A similar mechanism also likely explains why we see such a significant increase in bone diseases like avascular necrosis when patients are placed on any steroids. Now a new study this morning shows that women who get epidural steroids have a 280% increased risk of vaginal bleeding after the procedure. Why? The dose levels of steroid are very high for the body, so they end up whacking out the normal hormones that control the onset of a woman’s period. As I’ve blogged before, epidural steroids are also powerful enough to throw off the normal stress hormone axis for a few weeks. A 2012 study showed that these shots also hurt blood sugar control in diabetics. A 2009 study showed the same thing. The upshot? Epidural steroids have a huge hit of powerful anti-inflammatory steroid hormones that can have significant effects on the body. We’re just now beginning to understand these effects.