Doctor offered a cortisone shot for my other knee but my last DEXA said osteopenia. Will a steroid shot thin my bones?

Some of you know the left knee was done in January and has been mostly a success story, thanks to this board. Well, the right one has decided it's jealous. Swollen, hot, achy, worst flare I've had on that side. My regular doctor offered a cortisone shot right there in the office. I said I'd think about it, because here's my worry.

When they did my pre-op workup for the left knee they also sent me for a DEXA and it came back osteopenia, -1.8 at the spine. And everything I read about bone loss says steroids are one of the big causes. Deb's thread mentioned prednisone. So isn't a steroid shot the exact thing I'm supposed to avoid? Or is a shot in the knee different from pills?

Second question while I have you: if the right knee ends up needing replacing too, does a shot now mess that up?

Bev, good catch to even ask. When I started my bone med my doctor went down a list of things that "count" against bones and the steroid one she was specific about: she said "steroid tablets, for months." I remember because I asked about my inhaler and she said that's a different conversation. So I'd guess a shot is different, but ask, don't take my guess.

I'm the prednisone one. Mine was tablets, daily, for the better part of a year, and that was the thing that pushed my fracture number up. Nobody has ever mentioned the one time I had a shot in my shoulder. For what that's worth.

Had two in my left knee before it was replaced. First one was wonderful for about six weeks, second one maybe three. If I had it to do over I'd have used those weeks to get stronger instead of just enjoying them.

And on your second question, my surgeon wanted to know the date of the last shot before he'd book me. So yes, it matters, tell whoever you see.

Bev in Peoria said:

Or is a shot in the knee different from pills?

Different, in a way that matters, though not a free pass. The steroid that is clearly linked with bone loss is oral corticosteroid taken for months: daily tablets of prednisone or similar, which is why "long-term steroid tablets" is one of the inputs in fracture risk calculators. An occasional injection into a joint delivers a much smaller total dose, aimed at one place, and much of it stays in the knee. Some of it does reach the rest of the body, which is why people with diabetes see their blood sugar rise for a few days afterward, so frequent repeated injections are a different matter from a single one. Whether an injection is sensible with your bone density, your other medicines, and your history is a question for the doctor offering it, and it is a perfectly reasonable thing to ask them directly before you agree.

On the knee itself, it helps to know what the injection can and can't do. The best pooled evidence finds the benefit is largest at 1 to 2 weeks, smaller by 4 to 6 weeks, and largely gone by about 3 months, and a two-year trial of repeated injections every 3 months found no better pain relief than saline and slightly more cartilage loss. Sue's two experiences match that shape almost exactly. The site has just published a full guide to steroid injections for knee arthritis with those numbers and the side effects in detail.

Sue is right about the second question too. If a replacement on the right is a real possibility in the coming months, the surgeon will want the date of any injection, and many prefer a gap of several months between an injection and surgery on the same knee. If you think you might be heading that way, it's worth asking the surgeon's office before the injection rather than after.

Thank you, that's the clearest anybody has put it. Called my doctor's nurse line this morning with the two questions. She said one shot is not a concern for my bones at my numbers, but she agreed I should ask the surgeon who did my left knee first, since I'm seeing him in three weeks anyway for my one year... sorry, ten month check. So I'm going to wait, ice it, and let him look at both. A month of a grumpy knee I can manage.