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Harris A, Creecy A, Awosanya OD, McCune T, Ozanne MV, Toepp AJ, Kacena MA, Qiao X. SARS-CoV-2 and its Multifaceted Impact on Bone Health: Mechanisms and Clinical Evidence. Curr Osteoporos Rep 2024; 22:135-145. [PMID: 38236510 PMCID: PMC10912131 DOI: 10.1007/s11914-023-00843-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE OF REVIEW SARS-CoV-2 infection, the culprit of the COVID-19 pandemic, has been associated with significant long-term effects on various organ systems, including bone health. This review explores the current understanding of the impacts of SARS-CoV-2 infection on bone health and its potential long-term consequences. RECENT FINDINGS As part of the post-acute sequelae of SARS-CoV-2 infection, bone health changes are affected by COVID-19 both directly and indirectly, with multiple potential mechanisms and risk factors involved. In vitro and preclinical studies suggest that SARS-CoV-2 may directly infect bone marrow cells, leading to alterations in bone structure and osteoclast numbers. The virus can also trigger a robust inflammatory response, often referred to as a "cytokine storm", which can stimulate osteoclast activity and contribute to bone loss. Clinical evidence suggests that SARS-CoV-2 may lead to hypocalcemia, altered bone turnover markers, and a high prevalence of vertebral fractures. Furthermore, disease severity has been correlated with a decrease in bone mineral density. Indirect effects of SARS-CoV-2 on bone health, mediated through muscle weakness, mechanical unloading, nutritional deficiencies, and corticosteroid use, also contribute to the long-term consequences. The interplay of concurrent conditions such as diabetes, obesity, and kidney dysfunction with SARS-CoV-2 infection further complicates the disease's impact on bone health. SARS-CoV-2 infection directly and indirectly affects bone health, leading to potential long-term consequences. This review article is part of a series of multiple manuscripts designed to determine the utility of using artificial intelligence for writing scientific reviews.
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Affiliation(s)
- Alexander Harris
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amy Creecy
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Olatundun D Awosanya
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas McCune
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
- Division of Nephrology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Marie V Ozanne
- Department of Mathematics and Statistics, Mount Holyoke College, South Hadley, MA, USA
| | - Angela J Toepp
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
- Enterprise Analytics, Sentara Health, Virginia Beach, VA, USA
| | - Melissa A Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
| | - Xian Qiao
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
- SMG Pulmonary, Critical Care, and Sleep Specialists, Norfolk, VA, USA.
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
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Creecy A, Awosanya OD, Harris A, Qiao X, Ozanne M, Toepp AJ, Kacena MA, McCune T. COVID-19 and Bone Loss: A Review of Risk Factors, Mechanisms, and Future Directions. Curr Osteoporos Rep 2024; 22:122-134. [PMID: 38221578 PMCID: PMC10912142 DOI: 10.1007/s11914-023-00842-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW SARS-CoV-2 drove the catastrophic global phenomenon of the COVID-19 pandemic resulting in a multitude of systemic health issues, including bone loss. The purpose of this review is to summarize recent findings related to bone loss and potential mechanisms. RECENT FINDINGS The early clinical evidence indicates an increase in vertebral fractures, hypocalcemia, vitamin D deficiencies, and a loss in BMD among COVID-19 patients. Additionally, lower BMD is associated with more severe SARS-CoV-2 infection. Preclinical models have shown bone loss and increased osteoclastogenesis. The bone loss associated with SARS-CoV-2 infection could be the result of many factors that directly affect the bone such as higher inflammation, activation of the NLRP3 inflammasome, recruitment of Th17 cells, the hypoxic environment, and changes in RANKL/OPG signaling. Additionally, SARS-CoV-2 infection can exert indirect effects on the skeleton, as mechanical unloading may occur with severe disease (e.g., bed rest) or with BMI loss and muscle wasting that has also been shown to occur with SARS-CoV-2 infection. Muscle wasting can also cause systemic issues that may influence the bone. Medications used to treat SARS-CoV-2 infection also have a negative effect on the bone. Lastly, SARS-CoV-2 infection may also worsen conditions such as diabetes and negatively affect kidney function, all of which could contribute to bone loss and increased fracture risk. SARS-CoV-2 can negatively affect the bone through multiple direct and indirect mechanisms. Future work will be needed to determine what patient populations are at risk of COVID-19-related increases in fracture risk, the mechanisms behind bone loss, and therapeutic options. This review article is part of a series of multiple manuscripts designed to determine the utility of using artificial intelligence for writing scientific reviews.
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Affiliation(s)
- Amy Creecy
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Olatundun D Awosanya
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alexander Harris
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Xian Qiao
- Critical Care, and Sleep Specialists, SMG Pulmonary, Norfolk, VA, USA
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Marie Ozanne
- Department of Mathematics and Statistics, Mount Holyoke College, South Hadley, MA, USA
| | - Angela J Toepp
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
- Enterprise Analytics, Sentara Health, Virginia Beach, VA, USA
| | - Melissa A Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
| | - Thomas McCune
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
- Division of Nephrology, Eastern Virginia Medical School, Norfolk, VA, USA.
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