Spinal Fractures Could Signal Increased Risk for Severe COVID-19 Outcomes

Andrea Giustina, MD

Could spinal fractures help predict what patients are at an increased risk of severe outcomes with coronavirus disease 2019 (COVID-19)?

New research suggests patients with COVID-19 and vertebral fractures were twice as likely to die as their counterparts without spinal fractures.

“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,” said study investigator 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, in a statement. “A simple thoracic x-ray can detect these fractures and morphometric evaluation should be performed in COVID-19 patients at hospital admission.”

While a multitude of studies have examined clinical characteristics of COVID-19 patient, investigators found few had reported on the prevalence and impact of vertebral fractures in these patients. With this in mind, Giustina and a team of colleagues designed the current study to assess whether vertebral fractures might influence cardiorespiratory function and disease outcomes in patients with COVID-19.

Using the San Raffaele Hospital as the study center, investigators designed their study as a retrospective analysis of COVID-19 patients who had lateral chest X-rays from the hospital’s emergency department available. In total, 144 patients were identified for inclusion in the study. Of these, 41 were identified as having vertebral fractures—investigators pointed out these patients were typically older, more likely to be impacted by hypertension, have coronary artery disease than their counterparts without fractures.

Of note, osteoporosis was previously diagnosed in just 3 patients included in the study. Of the 144 included in the study, 90 were hospitalized after their initial evaluation in the emergency department, 13 were admitted to the intensive care unit, and 16 patients died during hospitalization.

Of the 41 patients with vertebral fractures, 28 had at least 1 mild fracture, 18 had at least 1 moderate fracture, and 5 had a fracture considered severe. Investigators pointed out 19 of the 41 patients with fractures had multiple fractures detected.

In comparison, 88% of patients in the fracture group were hospitalized while 74% of those without fractures underwent hospitalization. Results of the analysis suggested patients with vertebral fractures were more likely to require treatment with non-invasive mechanical ventilation than their counterparts without fractures (P=.02).

In regards to mortality, investigators reported rates of 22% for patients in the fracture group and 10% for those who did not experience fractures (P=.07). Investigators pointed out mortality was greater among patients with severe vertebral fractures compared to those with fractures considered mild or moderate (P=.04)

“Since thoracic VFs are easy to measure, associate with age and integrate the cardiorespiratory risk of COVID-19 patients and are a good marker of their fragility and poor prognosis we suggest that morphometric vertebral X-rays evaluation should be performed in all patients suspected for COVID-19,” wrote investigators.

This study, “Radiological Thoracic Vertebral Fractures are highly prevalent in COVID-19 and predict disease outcomes,” was published in the Journal of Clinical Endocrinology and Metabolism.