Endocrine Abstracts

Osteoporotic fractures are the main clinical manifestations of skeletal fragility and are associated with decreased survival and impaired quality of life in the general population. At the beginning of COVID-19 spread in Europe, despite several studies investigated COVID-19 clinical characteristics, no data were reported on the prevalence of vertebral fractures (VFs) in patients affected and disease impact on osteoporotic patients. We performed a retrospective study at San Raffaele Hospital, a tertiary health care hospital in Italy, to assess VFs prevalence including COVID-19 patients for whom lateral chest x-rays at emergency department were available. VFs were detected using a semi-quantitative evaluation of vertebral shape. A total of 114 patients were included and thoracic VFs were detected in 41 patients (36%). Patients with VFs were older and more frequently affected by hypertension and cardiovascular disease (P < 0.001, P = 0.007, P = 0.034). Thirty-six (88%) patients in VFs+ group and 54 (74%) in VFs- group were hospitalized (P = 0.08). Patients with VFs more frequently required noninvasive mechanical ventilation compared with those without VFs (P = 0.02). Mortality was 22% in VFs+ group and 10% in VFs- group (P = 0.07). In particular, mortality was higher in patients with severe VFs compared with those with moderate and mild VFs (P = 0.04). Furthermore, a recent review reported COVID-19 likely an additional mortality risk factor in patients with hip fractures exceeding the previously reported mortality rate in fractured patients or COVID-19 alone. The COVID-19 hyperinflammatory response may amplify the “first-hit” inflammatory state of fracture trauma and thereby predispose to a severe thromboembolic “second-hit”, whether the patient is symptomatic or not. VFs may integrate the cardiorespiratory risk of COVID-19 patients, being a useful clinical marker of fragility particularly in osteoporotic patients that are themselves at high risk of COVID-19 poor prognosis.