European Association for the Study of Diabetes 2020 Annual Meeting

EASD 2020

This article was originally published on Endocrinology Network's sister site, 

A new study analyzing from a pair of European registries is offering clinicians an overview of the various health benefits associated with 

 in severely obese patients with a history of 

The study’s results indicate undergoing Roux-en-Y gastric bypass and sleeve gastrectomy procedures was associated a lower risk of mortality, new MI, and other major adverse cardiovascular events (MACE) in severely obese patients with a history of MI.

"We found that individuals operated on for their obesity were at a much lower risk of suffering another myocardial infarction, of death and of developing heart failure," said lead investigator Erik Näslund, MD, PhD, professor at the Department of Clinical Sciences at Danderyd Hospital of the Karolinska Institute, 

 "These data suggest that severely obese people who suffer a myocardial infarction should be offered metabolic surgery for their obesity as a secondary prevention."

With the prevalence of obesity increasing throughout the world, determining the most effective course of treatment for obese patients is paramount. In an effort to evaluate whether metabolic surgery was an effective strategy for secondary prevention among obese patients, Naslund and colleagues designed the current study as an analysis of data from the SWEDEHEART and SOReg registries.

By combining data from the registries, investigators identified 509 patients with a BMI greater than 35 for inclusion in their analysis. These patients were then matched in a 1:1 ratio to controls with a history of MI but not undergoing metabolic surgery based on the sex, age, year of MI, and BMI of each patient. Investigators noted both groups were well-matched but pointed out patients in the surgery group had a lower proportion of reduced ejection fraction after MI (7% vs 12%), previous heart failure (10% vs 19%), atrial fibrillation (6% vs 10%), and chronic obstructive pulmonary disease (4% vs 7%).

The primary outcome of interest was MACE, which was defined as first occurrence of death or readmission with MI or stroke. Investigators chose individual components of the primary outcome, admission with not previously known atrial fibrillation, and admission because of previously unknown heart failure as secondary outcomes of the study.

During an 8-year follow-up period, which lasted a median of 4.6 (2.7–7.1) years, investigators found the probably of MACE was lower among patients who underwent metabolic surgery (18.7%; 95% CI, 15.9-21.5% vs 36.2%; 33.2-39.3% [aHR, 0.44; 95% CI, 0.32-0.61]).Patients undergoing surgery also had a lower risk of death (aHR, 0.45; 95% CI, 0.29-0.70), MI (aHR, 0.24; 95% CI, 0.14-0.41), and new onset heart failure. However, investigators pointed out there were no significant differences regarding stroke (aHR, 0.91; 95% CI, 0.38-2.20) and new onset atrial fibrillation (aHR, 0.56; 95% CI, 0.31-1.01).

Investigators also noted additional health changes at 2 years after metabolic surgery which could have contributed to reductions in primary and secondary outcome measures. Among these were a 67% remission in sleep apnea, 22% remission in hypertension, and a 29% remission in cholesterol and triglyceride levels in the surgery group. Additionally, results suggested more than half of the patients with type 2 diabetes experienced clinical remission after surgery.

Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Previous Myocardial Infarction and Severe Obesity

Articles

An analysis of data from European registries provide an overview of reductions in MACE and other benefits associated with metabolic surgery in severely obese patients with a history of myocardial infarction.

Weight Loss Surgery Helps Prevent Secondary Cardiovascular Events for Severely Obese

A Caucasian woman in her 30s presents to the emergency department for 10 days of gradually worsening generalized weakness, nausea without vomiting and occasional mid-abdominal pain. She also mentions that she has recently been on a keto-diet and also has had a surprising tan despite it being mid-winter. She denies any diarrhea, fever, missed periods or other complaints.

Vital signs are normal except for a BP of 85/61, which she does not think is normal for her. The pulse is 90 and temperature is 97.7. Physical exam is otherwise normal except for the skin findings and gum findings shown below.

: normal except for a sodium of 131, potassium of 5.3 and glucose of 62

Check out this Emergency Department Minute Quiz from Brady Pregerson, MD. Can you determine the correct diagnosis?

Emergency Department Minute Quiz: Weak and Tan

Data from an analysis of more than 12,000 postmenopausal women adds new evidence to the idea obesity can have a negative impact on 

Results of the analysis, which was conducted by a team from Finland and the UK, indicate obesity was associated with earlier hip fracture, higher post-fracture mortality, and greater rates of BMD loss in a cohort with 25 years of follow-up data.

“Obesity associated with both early hip fracture risk and higher all-cause mortality. The impact of BMI on hip fracture risk in the aging population is a complex and multifactorial topic. Numerous overlapping risk factors and competing events such as comorbidities, poor health behavior, low functional capacity, and excessive all-cause mortality commonly coexist with obesity,” wrote investigators.

Despite established links to increased risk for a multitude of comorbid conditions, debate still exists over the impact of increased BMI on bone health. With this in mind, investigators sought to assess the long-term effects of increased BMI on hip fracture incidence in a cohort of postmenopausal women. Using the data from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort, investigators identified 12,715 women for inclusion in their analysis.

Of note, OSTPRE includes more than 14,200 women born from 1932-1941 in a province in Finland. Beginning in 1989, these women received periodic questionnaires aimed at collecting information related to demographic and clinical characteristics of respondents. Based on these questionnaires, investigators established a pair of age classifications for the follow-up analysis—early (58-70 years) and late (more than 70 years).

Responders to the baseline questionnaire in 1989 were asked about their willingness to undergo bone densitometry and clinical measurement protocols. From this, investigators identified a subgroup of 3163 patients with data related to femoral neck bone mineral density (BMD).

The mean follow-up time for the current study cohort was 18.3 years. At baseline, the mean BMI was 26.7 kg/m2. Of the 12,715 women included, 39.6% met criteria for having normal body weight, 40% were considered overweight, 19.9% were considered obese, and 0.5% were considered underweight. A total of 427 occurred during the 233,096 person-years of follow-up.

Upon analysis, results indicated patients in both the obese (HR, 2.3; 95% CI, 1.4-3.7) and normal-weight (HR, 2.0; 95% CI, 1.3-3.1) groups had a higher risk of early hip fracture compared with the overweight group. This effect was not seen when assessing late hip fracture risk between the 3 BMI categories.

Further analysis indicated women considered obese were at a greater risk of mortality (HR, 1.6; 95% CI, 1.4-1.8) and had a greater baseline BMD than their counterparts in the normal weight group. Additionally, women considered obese appeared to have greater bone loss during the study period when compared against other groups of women (

“Obesity associates with earlier hip fracture and higher post-fracture mortality. The obese women with low BMD have clearly the highest risk of hip fracture. This combination increases hip fracture risk more than either of the factors alone,” wrote investigators.

Obesity is associated with early hip fracture risk in postmenopausal women: a 25-year follow-up

An analysis of data from 12k women in an ongoing Finnish study suggests obesity could signal increased risk for early hip fracture in postmenopausal women. 

Obesity Increases Early Hip Fracture Risk in Postmenopausal Women

New research from the Albert Einstein College of Medicine suggests statin use could reduce the risk of death by 12% in patients with 

 hospitalized with coronavirus disease 2019 (COVID-19).

An analysis of data from more than 4000 patients admitted to a New York medical center between March and May 2020, results of the study give credence to the idea the anti-inflammatory effect of 

“In this analysis involving a large cohort of hospitalized patients with COVID-19, statin use was associated with reduced in-hospital mortality in patients with diabetes,” wrote investigators. “This observation was made despite older age, higher prevalence of hypertension and atherosclerotic heart disease in diabetic statin users.”

With the anti-inflammatory effects of statin therapy described in multiple studies, a team led by Omar Saeed, MD, sought to determine whether use would impact outcomes in patients with COVID-19. With this in mind, they designed an analysis to assess data collected from within the Montefiore Medical Center in the Bronx, New York.

Using March 1, 2020 to May 2, 2020 as the study period, investigators conducted a retrospective analysis of consecutive patients admitted with COVID-19. Overall, 4252 patients were admitted during the study period. The mean age of this cohort was 65±16 years and 53% were male. Among the most prevalent comorbidities were atherosclerotic cardiovascular disease (23%), diabetes (53%), and hypertension (72%).

Among the 4252-patient cohort, 1355 received a statin. Those who received a statin were generally older and had a higher Charlson comorbidity index (5; IQR, 3-8 vs 3; IQR, 1-5; 

 <.01). Initial analysis indicated patients reviving a statin had a lower cumulative rate of in-hospital mortality compared to those not receiving a statin (23% vs 27%; 

 <.01), but investigators found the presence of diabetes modified this apparent effect.

Of the 4252 patients included in the study, 2266 were considered diabetic. Of these 2266, 983 received and 1283 did not receive a statin. When stratifying by diabetes status, patients with diabetes receiving a statin had a low cumulative in-hospital mortality than those not receiving a statin (24% vs 39%; 

 <.01), but no difference was observed among patients without diabetes (20% vs 21%; 

In a multivariable regression model, investigators determined statin use among patients with diabetes was associated with a 49% reduction for in-hospital mortality(HR, 0.51; 95% CI, 0.43-0.61). In propensity score-matched analyses using caliper matching (HR, 0.88; 95% CI, 0.83-0.94; 

 <.01) or inverse probably treatment waiting (HR, 0.88; 95% CI, 0.84-0.92; 

 <.01), statin use was associated with a 12% lower risk of death during hospitalization for statin users compared to non-users.

“In this observational analysis, statin administration to patients with diabetes was associated with a reduced risk of in-hospital mortality during COVID-19. Further study to validate our findings and investigate underlying mechanisms is needed,” wrote investigators.

Statin Use and In-Hospital Mortality in Diabetics with COVID-19,

Journal of the American Heart Association.

An analysis of data from patients presenting to a medical center in New York City details associations between statin use and mortality among diabetics hospitalized with COVID-19. 

Statin Use Lowers Mortality Risk in Diabetics with COVID-19

In recent years, awareness of racial and ethnic disparities in health care have gone from a topic of discussion to an actionable item in need of addressing. 

In a recent study, a team from the University of Pennsylvania examined racial and ethnic disparities in insulin pump use among children with 

 at a single center in Philadelphia. Upon analysis, results of the study indicated non-Hispanic White children were 2.5 times more likely to report insulin pump use than non-Hispanic Black children.

An analysis of rates within the center housing her own practice and those of her colleagues, Terri Lipman, PhD, CRNP, assistant dean of community engagement at the School of Nursing at the University of Pennsylvania, was a bit taken aback but noted she understands the importance of self-evaluation in the process of addressing these disparities.

In the following interview, Lipman offers clinicians advice on how clinicians can address the causes of disparities in care of children with type 1 diabetes on an individual and societal level.

Videos

The Assistant Dean of Community Engagement at the School of Nursing at the University of Pennsylvania offers perspective on addressing racial and ethnic disparities in medicine at an individual and societal level. 

Terri Lipman, PhD, CRNP: Addressing Racial and Ethnic Disparities in Medicine

This article originally appeared on Endocrinology Network’s sister publication,  

Data from the phase 3 FIDELIO-DKD trial indicate finerenone, a non-steroidal, selective mineralocorticoid receptor agonist made by Bayer, was effective at slowing the progression of chronic kidney disease (CKD) in patients with 

Presented at the American Society of Nephrology's Kidney Week 2020, results of the trial suggest finerenone lowered risk of CKD progression by 18% while also providing a 16% reduction in the study's cardiovascular outcome in a population of more than 5500 patients.

"We now have evidence that doctors can safely slow diabetic kidney disease progression and reduce cardiovascular event rates using finerenone, a novel nonsteroidal mineralocorticoid receptor blocker, not yet approved by the FDA. This is very important for a group of patients who've historically had very few options," said George Bakris, MD, Professor of Medicine at the University of Chicago, 

. "This promising target for a new therapy means patients are able to delay dialysis and, in turn, further delay the possible need for kidney transplants. The reduction in cardiovascular events is an added bonus to slowing kidney disease progression."

With previous studies reporting reductions in albuminuria during short-term trials involving patients with CKD and type 2 diabetes, FIDELIO-DKD was designed to provide a comprehensive understanding of the investigational therapy’s long-term effects on kidney and cardiovascular outcomes. Event-driven by design, the trial randomized a population of patients in a 1:1 ratio to treatment with finerenone or placebo.

For inclusion in the study, patients needed to be at least 18 years of age with type 2 diabetes and CKD while also being treated with an ACE inhibitor or ARB at maximum dose that did not cause unacceptable side effects. Investigators defined CKD as having a urinary albumin-to-creatinine ratio of 30 to less than 300, an eGFR of 25-60 ml/min/1.73 m2 of body surface area, and diabetic retinopathy, or as having urinary albumin-to-creatinine ratio of 300 to 5000 and an eGFR of 25-75 ml/min/1.73 m2.

Of note, patients randomized to finerenone with an eGFR of 25-60 ml/min/1.73 m2 at the screening visit received an initial dose of 10 mg once daily and those with an eGFR of 60 ml/min/1.73 m2 or more at the screening visit received an initial dose of 20 mg once daily.

For the primary outcome of the study, investigators assessed a composite of kidney failure, a sustained decrease of at least 40% in the eGFR from baseline over a period of at least 4 weeks, or death from renal causes in a time-to-event analysis. The key secondary outcome of the study, which was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure, was also assessed in a time-to-event analysis.

In total, 13,911 patients from 48 countries underwent screening and 5734 were included in randomization in the study. From this population, 5674 patients—2833 to finerenone and 2841 to placebo—were included in the final analysis.

Over a median follow-up of 2.6 years, investigators observed a primary outcome event among 17.8% (n=504) of patients randomized to finerenone and 21.1% (n=600) of patients randomized to the placebo group (HR, 0.82; 95% CI, 0.73-0.93; 

=.001). The key secondary outcome of the study occurred in 13% (n=367) of patients randomized to finerenone and 14.8% of those in the placebo group (HR, 0.86; 95% CI, 0.75-0.99; 

In regard to safety, results indicate frequency of adverse events was similar in both arms of the study. However, investigators pointed out the incidence of hyperkalemia-related discontinuation of the trial regimen was greater among those randomized to finerenone (2.3%) than those randomized to placebo (0.9%).

Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes

,” was presented at Kidney Week 2020 and simultaneously published in the 

Results from FIDELIO-DKD suggest finerenone was associated with reductions in progression of chronic kidney disease and potential improvements in cardiovascular health.

Finerenone Slows CKD Progression, Could Improve CV Health In Diabetic Kidney Disease

New research presented at the American Society of Nephrology’s Kidney Week 2020 is offering new insight into the ethnic differences in the association of kidney function and 

Results indicated associations between reduced kidney function and low bone mineral density (BMD) varied by race/ethnicity and based on the presence of hyperparathyroidism, suggesting adherence to guidelines for BMD screening in advanced CKD could help mitigate risk for these patients.

“To our knowledge, this is the largest contemporary and racially-diverse cohort in which bone density and kidney function have been examined. This study supports current CKD guidelines for BMD screening and suggest a relationship between kidney function and low BMD varied by ethnicity,” said Joshua Chang, MD, an internal medicine specialist at Kaiser Permanente Oakland Medical Center, during his presentation at Kidney Week 2020. 

With the presence of advanced CKD posing an immediate and serious risk factor for bone disease and fractures, Chang and a team of colleagues from Kaiser Permanente sought to describe the association between reduced kidney function and BMD in women. Using data from women attending medical centers run by Kaiser Permanente Northern California, investigators identified a cohort of more than 110,000 women with BMD testing from 1998-2017.

Investigators also planned to perform separate analyses to assess BMD and eGFR and another to assess hyperparathyroidism and calcium in a subgroup of women with advanced CKD and a BMD considered in the osteoporotic range.

For inclusion in the study, women needed to be between the ages of 60-79 years and have data related to BMD and serum creatinine levels within 1 year of BMD testing. Patients were excluded from the analysis if they were receiving osteoporosis or estrogen therapy, had metastatic cancer, or had previously received dialysis or a kidney transplant. For the subgroup analysis, women were required to have a BMD T-score of -2.5 or less and an eGFR of less than 45.

Overall, 83% of the 118,484 women included in the analysis had an eGFR greater than 60, 12% had an eGFR between 59-45, and 4% had an eGFR between 44-30, and 1% had an eGFR of 30 or less. Additionally, initial analysis indicated 12% of women between the age of 60-69 years had low BMD compared to 21% of women aged 70-79.

Results of the investigators' analysis indicated Asian women had the highest burden of low BMD. Among all race/ethnicity groups examined in the study, the burden of low BMD varied by eGFR and kidney function. Among patients with low BMD, advanced CKD, and measured hyperparathyroidism, 9.7% of patients with an eGFR less than 45 and 5.4% of patients with an eGFR of 30 or less were considered hypercalcemic.

Among patients meeting the criteria for hypercalcemia, 57% with eGFR of less than 45 had PTH of greater than 65 pg/mL and all patients with an eGFR of 30 or less had a PTH greater than 65 pg/mL. Among the remaining patients with calcium considered normal or low, 57% with an eGFR below 45 and 84% with an eGFR below 30 had PTH above 65 pg/mL.

“Our subgroup analysis, although small, showed hyperparathyroidism is a predominant metabolic disturbance in advanced CKD with low BMD. In our next steps, we plan to assess fragility fractures outcomes and findings in older men,” noted Chang at the end of his presentation.

Ethnic Differences in the Association of Kidney Function and Low Bone Density

,” was presented at ASN Kidney Week 2020.

Results of a study from ASN Kidney Week 2020 suggests low bone mineral density rates among women with CKD varied according to kidney function and race/ethnicity.

Bone Mineral Density in Women with CKD Varies by Race, Kidney Function

New research from a team in Tokyo is shedding light on the factors that could help clinicians predict the incidence of osteosarcopenia among postmenopausal women with 

With the coexistence of osteoporosis and sarcopenia putting patients at a greater risk of negative outcomes, the information provided from the retrospective analysis could allow for improved identification and management of these patients.

“The present study is the first to demonstrate the risk factors of developing osteosarcopenia, as assessed in an osteoporosis clinic. The results suggest that patients with low BMI have a higher risk of developing osteosarcopenia,” wrote study investigators. “Moreover, appropriate assessments, including the presence of comorbidities, will help in identifying patients at greater risk of developing osteosarcopenia, especially for patients aged 65–74 years.”

To learn more about the prevalence and impact of these conditions, investigators from the Showa University School of Medicine in Japan designed a retrospective analysis of patients regularly visiting the university hospital. From the hospital, investigators obtained data related to a cohort of 609 patients.

To be included, patients were required to be at least 65 years of age, diagnosed with postmenopausal osteoporosis, and to have undergone blood sampling and dual-energy x-ray absorptiometry between October 1, 2016 and September 31, 2017. Additional inclusion criteria included data related to handgrip strength, gait speed, and skeletal muscle mass index measurements. Of note, patients were excluded if they had osteoporosis other than postmenopausal osteoporosis or if they had severe chronic kidney disease requiring hemodialysis.

In total, 276 patients were included in the analysis. The mean age of this group was 77.07±6.74 years. When classifying patients according to diagnostic criteria of the Asian Working Group for Sarcopenia, 80.4% of the study population had osteoporosis alone and 19.6% met the criteria for osteosarcopenia.

Upon analysis, investigators found patients who met the criteria for osteosarcopenia had a greater risk of frailty compared to those with osteoporosis alone (OR< 2.33; 95% CI, 1.13-4.80; 

=.028). Results of the analysis also indicated low body mass index appeared to be the most significant factor related to the development of osteosarcopenia and investigators pointed out none of the 54 patients with osteosarcopenia were considered obese. Investigators noted low BMI (OR, 1.69; 95% CI, 1.22-2.32; 

 <.01), decreased kidney function (OR, 1.75; 95% CI, 1.12-2.72; 

=.01), and high levels of HbA1c (OR, 5.01; 95% CI, 1.40-18.55; 

=.01) appeared to be independent predictors of osteosarcopenia.

“The present study is the first to report that patients with osteoporosis aged 65–74 years who have comorbidities such as kidney dysfunction and abnormal glucose tolerance are at an increased risk of developing osteosarcopenia,” noted investigators.

Risk factors predicting osteosarcopenia in postmenopausal women with osteoporosis: A retrospective study

An analysis of more than 240 postmenopausal women with osteoporosis offers a glimpse into potential predictors of osteosarcopenia in this patient population.

Factors Associated with Osteosarcopenia in Postmenopausal Women with Osteoporosis 

New research from a team at the University of Nottingham has uncovered a link between increased exposure to corticosteroids and a greater risk of 

 and fragility fractures in older patients.

Results of the study concluded there was a dose-response relationship between cumulative dose of either oral or inhaled corticosteroid exposure with an increased risk of osteoporosis or fragility fracture.

“Our findings provide evidence that both oral corticosteroid and inhaled corticosteroid exposure have deleterious effects on bone health. We found a clear dose-response relationship, with higher cumulative doses and number of oral corticosteroid and inhaled corticosteroid prescriptions being associated with increased odds of osteoporosis and fragility fractures. The percentage of patients receiving bisphosphonates after oral corticosteroid initiation was low,” wrote investigators. 

With previous data detailing potential adverse effects associated with increased corticoid exposure use, a trio of investigators from the University of Nottingham sought to determine whether these therapies were associated with an increased risk of osteoporosis and fragility fractures. The current analysis was designed with the aim of assessing these associations in a comparison of a pair of nested case-control studies using data from the Clinical Practice Research Datalink and Hospital Episode Statistics databases.

For inclusion in their study, investigators required patients to be at least 18 years of age and have a Read code for asthma between April 2004-December 2017. Patients were also required to have at least 1 year of data collection prior to the diagnosis of asthma. Using the aforementioned databases, investigators identified cases defined by the first-record diagnosis of osteoporosis or fragility fractures.

For the purpose of the analysis, investigators examined the year prior to index date to determine exposure status to oral or inhaled corticosteroids. Investigators also queried information related to the use of bisphosphonate, which investigators pointed are recommended for patients to prevent the loss of bone density. Of note, fragility fractures were defined as a composite of vertebral, hip, forearm-wrist, and humeral fractures.

Upon analysis, results indicated a dose-response relationship between both the cumulative dose and number of oral corticosteroids and inhaled corticosteroids within the previous year and risk of osteoporosis or fragility fractures. In adjusted models, those receiving more oral corticosteroid prescriptions had a 4.5 (95% CI, 3.21-6.11) and 2.16 (95% CI, 1.56-3.32) times greater odds of osteoporosis and fragility fractures, respectively. Similarly, those receiving more inhaled corticosteroid was associated with 1.60 (95% CI, 1.22-2.10) and 1.31 (95% CI, 1.02-1.68) times greater odds of osteoporosis and fragility fractures, respectively.

Despite guidelines recommending use, results also suggested the rate of patients receiving 9 or more oral corticosteroid prescriptions and at least a single bisphosphonate prescription was just 50.6% and 48.4% for osteoporosis and fragility fractures, respectively.

“The use of OCS and ICS should be kept to the minimum necessary to treat symptoms and should be stepped down if symptoms and exacerbations are well managed. Bisphosphonate comedication should be considered according to guidelines for bone protection,” investigators wrote.

Risk of osteoporosis and fragility fractures in asthma due to oral and inhaled corticosteroids: two population-based nested case-control studies

A recent analysis suggests increased exposure to inhaled or oral corticosteroids was linked to an increased risk of osteoporosis and fragility fractures. 

Increased Exposure to Corticosteroids Could Increase Fracture Risk

Could spinal fractures help predict what patients are at an increased risk of severe outcomes with coronavirus disease 2019 (COVID-19)?

New research suggests patients with COVID-19 and vertebral fractures were twice as likely to die as their counterparts without spinal fractures.

“Vertebral fractures are a marker of frailty, and for the first time we show that individuals who have such fractures appear to be at increased risk of severe COVID-19,” said study investigator Andrea Giustina, MD, Director of the Institute of Endocrine and Metabolic Sciences of the San Raffaele Vita-Salute University and IRCCS San Raffaele Hospital in Milano, Italy, 

. “A simple thoracic x-ray can detect these fractures and morphometric evaluation should be performed in COVID-19 patients at hospital admission.”

While a multitude of studies have examined clinical characteristics of COVID-19 patient, investigators found few had reported on the prevalence and impact of vertebral fractures in these patients. With this in mind, Giustina and a team of colleagues designed the current study to assess whether vertebral fractures might influence cardiorespiratory function and disease outcomes in patients with COVID-19.

Using the San Raffaele Hospital as the study center, investigators designed their study as a retrospective analysis of COVID-19 patients who had lateral chest X-rays from the hospital’s emergency department available. In total, 144 patients were identified for inclusion in the study. Of these, 41 were identified as having vertebral fractures—investigators pointed out these patients were typically older, more likely to be impacted by hypertension, have coronary artery disease than their counterparts without fractures.

Of note, osteoporosis was previously diagnosed in just 3 patients included in the study. Of the 144 included in the study, 90 were hospitalized after their initial evaluation in the emergency department, 13 were admitted to the intensive care unit, and 16 patients died during hospitalization.

Of the 41 patients with vertebral fractures, 28 had at least 1 mild fracture, 18 had at least 1 moderate fracture, and 5 had a fracture considered severe. Investigators pointed out 19 of the 41 patients with fractures had multiple fractures detected.

In comparison, 88% of patients in the fracture group were hospitalized while 74% of those without fractures underwent hospitalization. Results of the analysis suggested patients with vertebral fractures were more likely to require treatment with non-invasive mechanical ventilation than their counterparts without fractures (

In regards to mortality, investigators reported rates of 22% for patients in the fracture group and 10% for those who did not experience fractures (

=.07). Investigators pointed out mortality was greater among patients with severe vertebral fractures compared to those with fractures considered mild or moderate (

“Since thoracic VFs are easy to measure, associate with age and integrate the cardiorespiratory risk of COVID-19 patients and are a good marker of their fragility and poor prognosis we suggest that morphometric vertebral X-rays evaluation should be performed in all patients suspected for COVID-19,” wrote investigators.

Radiological Thoracic Vertebral Fractures are highly prevalent in COVID-19 and predict disease outcomes

Journal of Clinical Endocrinology and Metabolism.

An analysis of more than 140 patients from a hospital in Italy suggests spinal fractures could help predict which patients were at an increased risk for negative outcomes with COVID-19. 