Good question. My thoughts. Discussed ESI with an endocrinologist and a rheumatologist once. Both said the same thing - if the ESI got the patient walking more, any negative effects from the steroid would be outweighed by the effect of exercise increase. Also looked up what other specialties do when giving steroids. According to old literature (have not reviewed in many years) if calcium supplements and Vitamin D is given it negates steroid effects on bone density. HOWEVER i know many docs who use osteoporosis from steroids as a reason to limit injections. What might be useful is an actual good study including all the factors i mentioned. So perhaps a patient who does not increase activity and does not take calcium and D and gets ESIs will develop osteoporosis from steroids. And the opposite patient gets stronger bones. All of what i just wrote is dated - i retired 5 years ago.
