From the Guidelines

Corticosteroid injections can negatively impact osteogenesis (bone healing).

The use of glucocorticoids (GCs) is associated with significant toxicity, including bone loss and fractures 1.
Both high daily and high cumulative GC doses increase the risk of fracture, particularly vertebral fracture, due to the greater effects of GCs on trabecular bone than on cortical bone 1.
The highest rate of bone loss occurs within the first 3–6 months of GC treatment, and a slower decline continues with persistent use 1.
Risk factors for GC-induced fracture include low bone strength at the beginning of GC treatment and the rate of decline in bone mass during treatment, which is largely determined by the dose and duration of GC use 1.
GC treatment is a potentially reversible risk factor for glucocorticoid-induced osteoporosis (GIOP); if GC treatment is terminated, bone mineral density (BMD) increases and fracture risk declines 1.

The American College of Rheumatology (ACR) has developed guidelines for the prevention and treatment of GIOP, which include recommendations for therapy to prevent bone loss 1.
Numerous risk calculators can be applied in clinical practice to provide estimates of risk of major OP fracture and hip fracture clinically diagnosed, with adjustment for GC dose in some but not all calculators 1.
It is essential to identify patients taking GCs for whom the benefits of preventive therapy sufficiently outweigh potential harms and to provide effective therapies to prevent fracture 1.

From the Research

The effect of corticosteroid injections on osteogenesis (bone healing) is a complex topic with varying results depending on the duration and dosage of corticosteroid treatment 2, 3, 4, 5, 6.
Short-term use of corticosteroids may not have a significant impact on bone healing, as shown in a study where no inhibitory effects were seen following short-term corticosteroid treatment in rats 2.
However, chronic use of corticosteroids has been shown to inhibit bone healing in a rabbit ulnar osteotomy model, with reduced radiographic union, bone mineral content, and mechanical strength compared to controls 4.
Long-term use of corticosteroids can lead to osteoporosis and increased risk of fracture, with various factors contributing to the risk of corticosteroid-induced osteoporosis, including smoking, excessive alcohol consumption, and hypogonadism 5.
The pathogenesis of glucocorticoid-induced osteoporosis involves increased bone resorption, inhibited osteoblastogenesis, and promoted apoptosis of osteoblasts and osteocytes, resulting in decreased bone formation 6.

Several factors can increase the risk of corticosteroid-induced osteoporosis, including:
- Smoking
- Excessive alcohol consumption
- Amenorrhoea
- Relative immobilisation
- Chronic obstructive pulmonary disease
- Inflammatory bowel disease
- Hypogonadism in men
- Organ transplantation 5
Non-pharmacological interventions, such as physical activity, adequate calcium and vitamin D intake, and avoidance of smoking and excessive alcohol consumption, can help manage the risk of fracture 5, 6.
Pharmacological management, including bisphosphonates, denosumab, and teriparatide, can be used to treat patients with increased fracture risk 6.