Risks of incident major osteoporotic fractures following SARS-CoV-2 infection among older individuals: a population-based cohort study in Hong Kong

David T. W. Lui, Xi Xiong, Ching-Lung Cheung, Francisco T. T. Lai, Xue Li, Eric Y. F. Wan, Celine S. L. Chui, Esther W. Y. Chan, Franco W. T. Cheng, Matthew S. H. Chung, Ivan C. H. Au, Chi-Ho Lee, Tai-Pang Ip, Yu-Cho Woo, Kathryn C. B. Tan, Carlos K H Wong, Ian C. K. Wong

Research output: Contribution to journalArticlepeer-review

Abstract

Population-based epidemiological studies on post-acute phase coronavirus 2019 (COVID-19)-related fractures in older adults are lacking. This study aims to examine the risk of incident major osteoporotic fractures following SARS-CoV-2 infection among individuals aged ≥50, compared to individuals without COVID-19. It was a retrospective, propensity-score matched, population-based cohort study of COVID-19 patients and non-COVID individuals identified from the electronic database of the Hong Kong Hospital Authority from January 2020 to March 2022. The primary outcome was a composite of major osteoporotic fractures (hip, clinical vertebral, and upper limb). COVID-19 patients were 1:1 matched to controls using propensity-score according to age, sex, vaccination status, medical comorbidities and baseline medications. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models. A total of 429 459 COVID-19 patients were included, 1:1 matched to non-COVID individuals. Upon median follow-up of 11 months, COVID-19 patients had higher risks of major osteoporotic fractures (5.08 vs 3.95 per 1000 persons; HR 1.22 95%CI [1.15–1.31]), hip fractures (2.71 vs 1.94; 1.33 [1.22–1.46]), clinical vertebral fractures (0.42 vs 0.31; 1.29 [1.03–1.62]), and falls (13.83 vs 10.36; 1.28 [1.23–1.33]). Subgroup analyses revealed no significant interaction. In acute (within 30 days) and post-acute phases (beyond 30 days) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we consistently observed a significant increase in fractures and falls risks. Our study demonstrated increased risk of major osteoporotic fractures after SARS-CoV-2 infection in both acute and post-acute phases in older adults, partly due to increased fall risk. Clinicians should be aware of musculoskeletal health of COVID-19 survivors.
Original languageEnglish
JournalJournal of Bone and Mineral Research
Early online date9 Mar 2024
DOIs
Publication statusE-pub ahead of print - 9 Mar 2024

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