ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) infection is linked to high levels of inflammatory cytokines and prolonged immobilization;furthermore, corticosteroid treatment leads to increased bone loss and resorption. We aimed to study the change in bone mineral density (BMD) after COVID-19 infection in osteoporotic and osteopenic patients. One hundred osteoporotic or osteopenic patients were selected in this single-center retrospective study;the patients were divided into two groups. Group 1 included 56 patients who got COVID-19 infection. Group 2 included 44 patients who did not get COVID-19 infection. BMD was assessed at baseline, after 9 months of COVID infection, and then after 1 year follow-up using dual energy x-ray absorptiometry (DXA) scan. Results: There was no significant difference between two groups regarding demographic data (p > 0.05);there was a significant decrease in BMD of the lumbar region and femur at 9 months as compared to baseline in group1 (p < 0.001), while there was a significant increase in the lumbar BMD of osteoporotic patients who did not get COVID infection after 21 months. Concerning activity of COVID infection, there was a significant difference between the three subgroups of COVID patients regarding percentage of change in BMD after 9 months, the severe group having the highest decrease in BMD (p < 0.001). Conclusions: COVID-19 may have deleterious effect on BMD in osteoporotic patients. It is recommended to assess BMD in osteoporotic/osteopenic patients who got COVID infection to detect if there is an increased risk of fracture which may necessitate post-COVID change in the therapeutic intervention plan. Supplementary Information: The online version contains supplementary material available at 10.1186/s43166-022-00165-7.
ABSTRACT
Background: Glucocorticoid (GC) use is well established in the treatment of rheumatics diseases, particularly rheumatoid arthritis (RA). The use of low dose GC has been endorsed by EULAR recommendations for the management of rheumatic and musculoskeletal diseases even if in the context of SARS-CoV-2, but long-term use is generally discouraged. Objectives: To estimate the prevalence of glucocorticosteroids induced osteoporosis (GIOP) on bone mineral density (BMD) in African adult patients with infammatory rheumatic diseases. Methods: For this systematic review and meta-analysis, PubMed, Google Scholar, Scopus and African index medicus were systematically searched up to December 2020 without language restrictions. We included studies as follows: population-based or hospital-based study, study with sufficient information to estimate the prevalence of GIOP and osteoporotic fractures in African patients with rheumatic disease. Searches were limited to peer-reviewed full text articles. A standardized data extraction form was used to collect information from eligible studies. A random-effects meta-analysis was conducted to obtain the pooled prevalence of GIOP in these studies. The meta-analysis was strati-fed by geographical region. The study is registered with PROSPERO, number CRD42021256252. Results: Our search identifed 8571 studies, of which 8 studies were included in the systematic review from only four African countries and 7 studies in the meta-analysis. The pooled prevalence of osteoporotic fractures in our study was 47.7% (95% CI 32.9-62.8) with 52.2% (95% CI 36.5-67.6) in North Africa and 15.4% (95% 1.9-45.4%) in South Africa (SA). There was no evidence of publication bias, although heterogeneity was high (p=0.018). There was no data from sub-Saharan Africa apart from the two studies from SA. Conclusion: The overall prevalence of GIOP in African adult patients with infam-matory rheumatic diseases was high at 47.7% (95% CI 32.9-62.8). Meta-analysis calculation revealed patient geographic origin as possible confounding factors of the proportion outcomes and further studies are required.