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

• Published in: Journal of bone and mineral research 2024-05, Vol.39 (5), p.551-560
• Main Authors: Lui, David T W, Xiong, Xi, Cheung, Ching-Lung, Lai, Francisco T T, Li, Xue, Wan, Eric Y F, Chui, Celine S L, Chan, Esther W Y, Cheng, Franco W T, Chung, Matthew S H, Au, Ivan C H, Lee, Chi-Ho, Ip, Tai-Pang, Woo, Yu-Cho, Tan, Kathryn C B, Wong, Carlos K H, Wong, Ian C K
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cohort Studies; COVID-19 - complications; COVID-19 - epidemiology; Female; Hong Kong - epidemiology; Humans; Incidence; Male; Middle Aged; Osteoporotic Fractures - epidemiology; Proportional Hazards Models; Retrospective Studies; Risk Factors; SARS-CoV-2
• ISSN: 0884-0431; 1523-4681; 1523-4681
• DOI: 10.1093/jbmr/zjae041

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.