Radiological Thoracic Vertebral Fractures are Highly Prevalent in COVID-19 and Predict Disease Outcomes
The Journal of Clinical Endocrinology & Metabolism, 2020, Vol. XX, No. XX, 1-13
doi:10.1210/clinem/dgaa738
Luigi di Filippo,1 Anna Maria Formenti,1 Mauro Doga,1 Erika Pedone,1 Patrizia Rovere-Querini,2 and Andrea Giustina1 ORCiD number: 0000-0001-6783-3398
- 1Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan 20132, Italy; and
- 2Vita-Salute San Raffaele University and Division of Transplantation, Immunology and Transplantation Diseases, San Raffaele Scientific Institute, Milan 20132, Italy
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Items in both categories Diabetes and Virus
- T1 Diabetes increased by 27% by second year of COVID – meta-analysis June 2023
- Diabetes 3X more likely if had COVID ICU (VDR was deactivated) - April 2023
- Active vitamin D is related to COVID and Diabetes in 15 ways – Dec 2022
- T1 Diabetic adults 5X more likely to get COVID (hint low vitamin D)– Nov 2022
- Vitamin D separately helps X or COVID, should help X with COVID (example: diabetes) – March 2022
- COVID-19 hospitalizations: 63% associated with diabetes, obesity, hypertension or heart failure – Feb 2021
- Diabetes has many bidirectional links with COVID-19 – March 2021
- 26 health factors increase the risk of COVID-19 – all are proxies for low vitamin D
- Excessive insulin decreases vitamin D in 4 ways – problems for diabetic COVID-19 – Dec 2020
- Hyperglycemic 2X more likely to have severe COVID-19 - Nov 2020
- Diabetes increases COVID-19 severity and COVID-19 creates Diabetes - Oct 2020
- COVID-19 deaths 4 to 7 X more likely if Diabetic, Hypertensive, or CVD - meta-analysis March 2020
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Less aborption of Vitamin D from food
Shift Workers
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Breathing Problems
- COVID-19 plus pneumonia in ICU with low vitamin D equaled Death - Dec 2020
- COVID-19 lung death 4X more likely in Iran if less than 25 ng of vitamin D – Oct 30, 2020
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Low D ==> Higher COVID-19 Risk
- 5X more likely to test positive for COVID-19 if low vitamin D in previous 5 years (900,000 people) - Dec 4, 2020
- 5.8 X more likely to die of COVID-19 if low vitamin D - Systematic Review Dec 3, 2020
- Hospital COVID-19 observation: 7X more likely to live if more than 20 ng of vitamin D– Nov 19, 2020
26 health factors increase the risk of COVID-19 – all are associated with low vitamin D
26 health factors increase the risk of COVID-19 – all are proxies for low vitamin D
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- Cancer
- Chronic kidney disease
- COPD (chronic obstructive pulmonary disease)
- Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
- Immunocompromised state (weakened immune system) from solid organ transplant
- Obesity (body mass index (BMI) of 30 kg/m2 or higher but < 40 kg/m2)
- Severe Obesity (BMI ≥ 40 kg/m2)
- Pregnancy
- Sickle cell disease
- Smoking
- Type 2 diabetes mellitus
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Context and Objective: COVID-19 has become the most relevant medical issue globally. Despite several studies that have investigated clinical characteristics of COVID-19 patients, no data have been reported on the prevalence of vertebral fractures (VFs). Since VFs may influence cardiorespiratory function and disease outcomes, the aim of this study was to assess VFs prevalence and clinical impact in COVID-19.
Design and Patients: This was a retrospective cohort study performed at San Raffaele Hospital, a tertiary health care hospital in Italy. We included COVID-19 patients for whom lateral chest x-rays at emergency department were available. VFs were detected using a semiquantitative evaluation of vertebral shape on chest x-rays.
Results: A total of 114 patients were included in this study and thoracic VFs were detected in 41 patients (36%). Patients with VFs were older and more frequently affected by hypertension and coronary artery disease (P < 0.001, P = 0.007, P = 0.034; respectively). Thirty-six (88%) patients in VFs+ group compared to 54 (74%) in VFs- group were hospitalized (P = 0.08). Patients with VFs more frequently required noninvasive mechanical ventilation compared with those without VFs (P = 0.02). Mortality was 22% in VFs+ group and 10% in VFs- group (P = 0.07). In particular, mortality was higher in patients with severe VFs compared with those with moderate and mild VFs (P = 0.04).
Conclusions: VFs may integrate the cardiorespiratory risk of COVID-19 patients, being a useful and easy to measure clinical marker of fragility and poor prognosis. We suggest that morphometric thoracic vertebral evaluation should be performed in all suspected COVID-19 patients undergoing chest x-rays.