FRI679 Risks Of Incident Major Osteoporotic Fractures Following SARS-CoV-2 Infection
Authors: Lui David , Xiong Xi , Chung Matthew , Au Ivan , Lai Francisco , Wan Eric , Chui Celine , Li Xue , Cheng Franco , Cheng Ching Lung , Chan Esther , Lee Chi Ho , Pang Ip Tai , Woo Yu Cho , Tan Kathryn , Wong Carlos , Wong Ian 
Published: October 2023

Abstract
Disclosure: D. Lui: None. X. Xiong: None. M. Chung: None. I. Au: None. F. Lai: None. E. Wan: None. C. Chui: None. X. Li: None. F. Cheng: None. C. Cheng: None. E. Chan: None. C. Lee: None. T. Ip: None. Y. Woo: None. K. Tan: None. C. Wong: None. I. Wong: None.
Objectives: Pre-clinical and small cohort studies have suggested the potential deleterious effects of SARS-CoV-2 infection on bone health. We aimed to estimate the risks of incident fractures following SARS-CoV-2 infection in a population-based cohort. Methods: This 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, proximal humerus and wrist fractures), identified by the ICD-9-CM codes 805.x, 812.x, 813.x, 814.x, 820.x. Episodes of falls were identified by the ICD-9-CM codes 781.2, 781.3, 781.99, V15.88, E880-E888. COVID-19 patients were 1:1 matched to controls using propensity-score according to age, sex, comorbidities and medications. The cohort was followed up until the occurrence of outcomes, death, or 31 January 2023, whichever came first. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models. Results: 740,692 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 (0.35% vs 0.29%; HR 1.21, 95%CI 1.14-1.29, p&lt;0.001), hip fractures (0.16% vs 0.11%; HR 1.34, 95%CI 1.23-1.47, p&lt;0.001), and fall (0.89% vs 0.65%; HR 1.29, 95%CI 1.24-1.34, p&lt;0.001). There was also statistically non-significant increased risk of clinical vertebral (0.03% vs 0.02%; HR 1.22, 95%CI 0.99-1.50, p=0.062) and upper limb (0.14% vs 0.12%; HR 1.08, 95%CI 0.99-1.18, p=0.081) fractures. Subgroup analyses revealed no significant interaction by age (&lt;60 vs ≥60 years), presence of diabetes, fracture history, and the predominant SARS-CoV-2 variant. However, the impact of SARS-CoV-2 infection on fracture and fall risks was greater among men (p-interaction&lt;0.001) and unvaccinated people (p-interaction=0.015). Among COVID-19 patients, hospitalised and dexamethasone-treated ones had higher subsequent fracture and fall risks. When dividing the follow-up period into the acute phase (within 30 days after SARS-CoV-2 infection) and the post-acute phase (beyond 30 days after SARS-CoV-2 infection), the risk of major osteoporotic fractures and falls was consistently increased in the whole cohort, particularly among the older individuals (≥60 years). Conclusions: Our study demonstrated increased risk of major osteoporotic fractures following SARS-CoV-2 infection, contributed by increased fall risk. Clinicians should be aware of musculoskeletal health of COVID-19 survivors, especially older individuals, and provide appropriate preventive actions.
Presentation: Friday, June 16, 2023