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Bones under “fire” in the event of Covid-19. Chronic sufferers like osteoporosis can have a worse prognosis and especially in the post-Covid period it is essential to pay attention to bone strength and the possible risk of osteoporosis, which can also be linked to the need for cortisone-based therapies.
The alarm was raised by the experts who met at the recent CUEM congress. A study presented there, conducted in our country, allows us to understand the delicate relationships even better between bone health and Covid-19, Sars-CoV-2 virus infection.
The research was published in the Journal of Clinical Endocrinology & Metabolism and linked the prevalence of vertebral fractures and the clinical impact of the virus. The study included 114 patients undergoing lateral chest radiography upon access to the emergency room.
Vertebral fractures were identified in 36% of the patients studied, who were also more frequently affected by hypertension and coronary heart disease. The condition of 88% of patients with fractures required hospitalization compared to 14% of those without bone damage even in deaths affecting 22% of those with fractures compared to 10% of those without with a higher mortality in the people with more severe vertebral damage than those whose fractures were moderate or mild.
Fractures make “fragile”
“Vertebral fractures have proved to be a simple marker of frailty and given their very high prevalence and their predictive power of a worse outcome, they could be fully included among the comorbidities already known to have a negative impact on prognosis such as hypertension, diabetes and obesity – explains Andrea Giustina, Co-President of CUEM and head of the Institute of Endocrine and Metabolic Sciences at the IRCCS Vita-Salute San Raffaele University in Milan ”.
Hospitalized Covid-19 patients showed a particular predisposition to bone fragility with high risk of fractures. The factors behind this observation could be multiple including high levels of pro-inflammatory cytokines, low calcium levels, older age, other concomitant diseases such as diabetes mellitus and glucocorticoid treatments associated with prolonged immobilization and loss of muscle mass.
In this sense it is important to note that the cortisone therapy that has proved effective in improving the estio of hospitalized Covid-19 patients has important metabolic side effects on the bone that must be kept in mind especially in those patients who continue to take cortisone for a long time and therefore in the post Covid phase.
Not just women at risk
But be careful: we must not think that the problem is only female. “A common denominator – concludes Giustina – between the studies on Covid-19 and chronic corticosteroid therapies is that vertebral fractures in these conditions do not in any way spare the male sex who was at least as affected as the female sex.
This feedback must be a stimulus for all professionals but also for the general population of don’t neglect bone health in the male, avoiding falling into that gender reverse bias that sees osteoporosis as an exclusively female pathology. The dosage of vitamin D, which is also so important for its role in supporting immune defense, and an MOC-DEXA assessment of bone mass in men at risk of osteoporosis or who have already suffered a fracture are important elements of good clinical practice “.
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