COVID-19 illness and treatment decrease bone mineral density of surviving hospitalized patients

The number patients surviving COVID-19 hospitalization is steadily increasing. Follow-up management for these patients relies on an understanding of the long-term effects of COVID-19. Specifically, there are insufficient data about the lasting effects of COVID-19 on bone health. We aim in this study to evaluate whether COVID-19 illness and treatment adversely affect the bone health of surviving patients.

We assessed the bone mineral density (BMD) of hospitalized COVID-19 patients at diagnosis and at follow-up visits. Using the chest computed tomography (CT) scans of patients that were obtained for clinical management at diagnosis and follow-up visits, BMD was retrospectively measured by quantitative CT. The effect of COVID-19 severity markers and treatment-related factors on BMD were also assessed.

BMD decreased by a mean of 8.6% (± 10.5%) from diagnosis to follow-up. The follow-up visits occurred at a mean of 81 (± 48) days after hospital discharge. The BMD decrease was significantly greater than expected for age-related annual BMD loss. The osteoporosis ratio increased two-fold after hospitalization for COVID-19 because of this substantial bone loss. On multivariable linear regression, only severity of COVID-19 pneumonia on initial chest CT and total steroid dose were predictive of change in BMD after COVID-19 hospitalization.

Secondary osteoporosis may occur as a post-acute sequela of COVID-19. Therefore, the bone health status of patients surviving COVID-19 hospitalization should be monitored closely at follow-up visits, to facilitate the prevention and early treatment of osteoporosis complications.