Vertebral fractures ‘objective clinical marker’ of frailty, prognosis in COVID-19
Click Here to Manage Email Alerts
Morphometric vertebral fractures are one of the most common comorbidities among adults hospitalized with COVID-19, and the presence of such fractures may predict the severity of disease outcomes, study data show.
“Skeletal fragility is much more common than thought, particularly among older adults,” Andrea Giustina, MD, professor of endocrinology, director of the Institute of Endocrine and Metabolic Sciences at San Raffaele Vita-Salute University and IRCCS San Raffaele Hospital in Milan, and president of the European Society of Endocrinology, told Healio. “Vertebral fractures are a marker of frailty and the significance of our study is that, for the first time, we show that those bearing such fractures appear to be at increased risk for severe COVID-19.”
Morphometric vertebral evaluation should be performed for those diagnosed with COVID-19 at hospital admission. Andrea Giustina, MD
In a retrospective study, Giustina and colleagues analyzed data from 114 patients presenting to the hospital with a confirmed diagnosis of COVID-19 who underwent lateral chest X-rays at ED admission (74.6% men; median age, 57 years). Researchers detected vertebral fractures using a semiquantitative evaluation of vertebral shape on chest X-rays. Patient data were collected from medical chart review or via patient interview and were entered into a dedicated case record form for the COVID-BioB study, a large observational study at San Raffaele University Hospital.
Within the cohort, 90 patients were hospitalized after an initial ED evaluation, with 13 admitted to the ICU. Researchers observed thoracic vertebral fractures in 41 patients (36%). In all, researchers observed 65 vertebral fractures, with 60% classified as mild, 33.3% classified as moderate and 7.7% classified as severe. Osteoporosis was previously diagnosed in only three patients (2.8%).
“We found that vertebral fractures were highly prevalent in our study population, as up to 36% of patients presented a vertebral deformity, although only 3% had a previous diagnosis of osteoporosis reported in their past medical history,” the researchers wrote.
Patients with vertebral fractures were older vs. those without vertebral fractures (P < .001) and were more likely to have hypertension (P = .007) and coronary artery disease (P = .034). Compared with patients without vertebral fractures, those with vertebral fractures were more likely to be hospitalized (88% vs. 74%; P = .08). Additionally, patients with vertebral fractures more frequently required noninvasive mechanical ventilation compared with those without vertebral fractures (48.8% vs. 27.4%; P = .02).
The overall COVID-19 mortality rate was double for those with vs. without vertebral fractures, although the number did not rise to significance (22% vs. 10%; P = .07); however, researchers observed higher mortality among patients with severe vertebral fractures compared with those with moderate and mild vertebral fractures (P = .04).
The researchers noted that vertebral fractures and their severity can be an “objective clinical marker” of frailty and negative prognosis among patients with COVID-19.
“A simple thoracic X-ray can detect these fractures,” Giustina said. “In light of its predictive value, morphometric vertebral evaluation should be performed for those diagnosed with COVID-19 at hospital admission.”
Giustina said more research is needed on whether fracture prevention can protect from severe COVID-19, or whether vitamin D supplementation might be beneficial by positively influencing bone health as well as immune response.
For more information:
Andrea Giustina, MD, can be reached at giustina.andrea@hsr.it; Twitter: @ESEPresident.
Perspective
Back to Top
Bart L. Clarke, MD
This is an interesting study from a well-known group of researchers. This is, of course, a representative sample, but the findings are believable. We know that people with severe COVID-19 infection tend to have other comorbidities; those other comorbidities predict fracture risk, too, so it is not surprising to see that patients who did not fare as well with this disease had increased vertebral fractures. There does seem to be a correlation between the presence of vertebral fractures and COVID-19 outcomes — the more severe the vertebral fractures, the greater the mortality risk.
In the bone world, we have been looking for COVID-19 associations. So far, there has not been much published, although the expectation is people hospitalized with COVID-19 tend to be sicker, older people who have conditions like osteoporosis. This paper establishes a link between the skeleton and COVID-19, which, prior to now, we have not really had. There are limitations, too. The authors acknowledge that they did not have prior X-Ray data to look back on to determine which fractures were prevalent already vs. fractures perhaps associated with the upper respiratory infection due to coughing, which can provoke vertebral or rib fractures in older adults. Researchers will likely conduct similar studies at larger centers going forward using electronic health record databases, and it will be interesting to see those findings. This is a good start.
Collapse
Read more about
Click Here to Manage Email Alerts