Vertebral Fractures Associated With COVID-19 Severity and Prognosis

A Doctor reviewing her patients x-ray results for possibly breaks, fractures and abnormalities
Vertebral fractures may be an easily obtained indicator of cardiorespiratory risk and COVID-19 prognosis.

Vertebral fractures may serve as a useful clinical marker of fragility and poor prognosis in coronavirus disease 2019 (COVID-19) patients, according to the results of a prospective study published in The Journal of Clinical Endocrinology & Metabolism.

Studies have investigated clinical characteristics of COVID-19 patients, but the prevalence of vertebral fractures in COVID-19 patients had not yet been reported. To determine the prevalence and clinical impact of vertebral fractures in patients with COVID-19, researchers analyzed data from 114 patients (25.4% women) who received a confirmed diagnosis of COVID-19 and who had a high quality lateral chest x-ray.

The median age of patients was 57 years. A confirmed diagnosis was required to occur after admission to the emergency department (ED), not after admission to the hospital for any other reason. Patients with multiple fractures were classified by their most severe degree of fracture.

Thoracic vertebral fractures at the time of admission to the ED were detected in 36% of patients. Vertebral fractures were significantly associated with arterial hypertension (P <.007) and coronary artery disease (P =.034). The median age of patients with vertebral fractures was 12 years older than those without vertebral fractures (P <.001).

Patients with vertebral fractures were more likely to require noninvasive mechanical ventilation than those without these fractures (P =.02). Mortality was higher in patients with severe vertebral fractures than those with moderate and mild fractures (P =.04).

Taken together, these findings indicated that vertebral fractures are one of the most frequent comorbidities in severe cases of COVID-19, perhaps due to a correlation with cardiorespiratory risk. The significant difference in mortality of patients with severe vertebral fractures compared to those with mild or moderate vertebral fractures but no other clinical or laboratory differences indicates that the severity of vertebral fractures is a strong indicator for the severity of COVID-19. Vertebral fractures may be an easily obtained indicator of cardiorespiratory risk and COVID-19 prognosis.

Limitations to this study include its retrospective nature and lack of data regarding the timing of vertebral fractures. Because the data in this study were collected during a period of severe strain on EDs, lateral chest X-rays were not collected for many patients who were diagnosed with COVID-19 during the study period, resulting in a small study population. Data regarding body mass index and vitamin D levels were not available, preventing a more thorough evaluation of bone metabolic status.

The study authors recommend that patients with fractures begin antiresorptive treatment as soon as possible, including while they are still patients in the hospital, and that patients continue to have their bone density monitored on an ongoing basis.

Future studies with a larger study population and additional data relating to bone health are warranted.


di Filippo L, Formenti AM, Doga M, Pedone E, Rovere-Querini P, Giustina A. Radiological thoracic vertebral fractures are highly prevalent in COVID-19 and predict disease outcomes. Published online October 21, 2020. J Clin Endocrinol Metab. doi: 10.1210.clinem/dgaa738