The Impact of COVID-19 in Bone Metabolism: Basic and Clinical Aspects

Abstract

The use of standard procedures for the diagnosis of osteoporosis and assessment of fracture risk significantly decreased during the COVID-19 pandemic, while the incidence of fragility fractures was mostly unaltered. Both COVID-19 per se and its treatments are associated with a negative impact on bone health. Preclinical models show that mice infected with SARS-CoV2 even without symptoms display loss of trabecular bone mass two weeks post infection, due to increased numbers of osteoclasts. Osteoporosis medications do not aggravate the clinical course of COVID-19, while preclinical data suggests possible beneficial effects of some therapies. While vitamin D deficiency is clearly associated with a worse clinical course of COVID-19, evidence of improved patient outcome with vitamin D supplementation is lacking. Osteoporosis treatment should not be generally discontinued, and recommendations for substituting therapies are available. Osteoporosis therapies do not interfere with the efficacy or side-effect profiles of COVID-19 vaccines and should not be stopped or indefinitely delayed because of vaccination.

Key words

COVID-19 - SARS-CoV2 - bone/calcium homeostasis - osteoporosis - osteopenia - fractures - vitamin D - vaccines

Publication History

Received: 14 March 2022

Accepted after revision: 13 April 2022

Accepted Manuscript online:
13 April 2022

Article published online:
20 June 2022

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