COVID-19 Patients with Spinal Fractures Twice as Likely to Die

Patients with COVID-19 and vertebral fractures are twice as likely to die from the virus, according to a study recently published in The Journal of Clinical Endocrinology & Metabolism.

Researchers led by Andrea Giustina, MD, Director of the Institute of Endocrine and Metabolic Sciences of the San Raffaele Vita-Salute University and IRCCS San Raffaele Hospital in Milano, Italy, point out that osteoporosis is one of the worldwide major health issues, and that vertebral fractures are associated with decreased survival and impaired quality of life. “[O]ther authors have hypothesized a possible increase in risk of fragility fractures and related mortality after the COVID-19 pandemic due to the strain on the health system during the emergency, with consequent interruption of adequate care for the patient with chronic diseases,” the authors write. “However, beyond these expert opinions no real data are yet available on the hard clinical endpoint of bone fragility, ie, fracture rates, in hospitalized COVID-19 patients.”

In a retrospective cohort study performed at a tertiary care hospital in Italy, the researchers studied the x-rays of 114 COVID-19 patients and detected thoracic vertebral fractures in 35%. These patients were older and more affected by high blood pressure and heart disease. They were more likely to need ventilators and were twice as likely to die compared to those without fractures. The death rate was higher in patients with severe fractures.

Based on these findings, the authors conclude that “since thoracic VFs are easy to measure, associate with age, and integrate the cardiorespiratory risk of COVID-19 patients, they are a good marker of patient fragility and poor prognosis and we suggest that morphometric vertebral x-rays evaluation should be performed in all patients with suspected COVID-19.”

“Vertebral fractures are a marker of frailty, and for the first time we show that individuals who have such fractures appear to be at increased risk of severe COVID-19,” Giustina says. “A simple thoracic x-ray can detect these fractures and morphometric evaluation should be performed in COVID-19 patients at hospital admission.”