Objectives
COVID-19 lockdowns predisposed people to sedentary lifestyles and unhealthy behaviours which may have affected bone mineral density (BMD) and fragility fracture risk. However, limited studies describe such an association. We aimed to investigate how COVID-19 lockdowns has affected BMD and fragility fractures in a large cohort.
Methods
Patients were referred to our DEXA scanner from 2004 to 2024 and were subsequently categorised as pre- or post-March 23, 2020 (pre and post-COVID-19) to allow analysis between the groups. Demographic, BMD, and compositional data were compared between the 2 populations. A Multivariate logistic regression modelled the odds of reporting a fracture including hip and non-hip fracture. A multiple linear regression was used to model how the lockdown has affected bone density. All analyses were adjusted for confounders.
Results
Of 43,799 referrals, 6,564 were post-COVID-19. Post-COVID-19 patients had higher non-hip fracture rates (42.0% vs.s 39.8%), were 3 kg heavier, and had lower left femoral T-scores. Patients referred post-COVID-19 had a statistically significant reduction of -0.23 to their T-score after adjusting for confounders as well as increased risk of getting diagnosed with osteoporosis (OR 1.49, 95% CI 1.40,1.59). Patients referred after the pandemic had a reduced odds of any fracture (OR 0.83, 95% CI 0.77, 0.88), hip (OR 0.74, 95% CI 0.62, 0.88) and non-hip fracture (OR 0.78, 95% CI 0.73, 0.83).
Conclusion
COVID-19 lockdowns may have negatively affected bone; however, this has not translated to an increased fracture risk in our study. Further research Is needed with prospective cohorts to corroborate this risk.