The Impacts of COVID-19 on Musculoskeletal Health

Abstract

Purpose of Review Although COVID-19 was originally characterized as a respiratory disease, recent findings have shown lingering side effects in those who have recovered, and much is still unknown about the long-term consequences of the illness. Thus, the potential of unearthing multi-system dysfunction is high, with current data revealing significant impacts on musculoskeletal health. Recent Findings Multiple animal models of COVID-19 infection have revealed significant post-infection bone loss at several different skeletal sites. While how this loss occurred is unknown, this current review discusses the primary bone loss studies, and examines the possible mechanisms of action including: direct infection of bone marrow macrophages or hematopoietic progenitors, a proinflammatory response as a result of the COVID-19 induced cytokine storm, and/or a result of hypoxia and oxidative stress. This review will further examine how therapeutics used to treat COVID-19 affect the skeletal system. Finally, this review will examine the possible consequence that delayed care and limited healthcare accessibility has on musculoskeletal-related patient outcomes. Summary It is important to investigate the potential impact COVID-19 infection has on musculoskeletal health.

Causal relationships between COVID-19 and osteoporosis: a two-sample Mendelian randomization study in European population

“…Qiao et al demonstrated that bone loss is associated with SARS-CoV-2-induced cytokine dysregulation, as circulating proinflammatory cytokines not only upregulate osteoclastic differentiation in bone tissues but also trigger an amplified proinflammatory cascade in skeletal tissues to augment their pro-osteoclastogenesis effect ( 29 ). It has been suggested that hypoxia and oxidative stress may play a role in the development of osteoporosis in COVID-19 patients ( 30 ). Severe COVID-19-induced hypoxemia can trigger the excessive production of reactive oxygen species (ROS), which disrupts the balance of redox homeostasis ( 31 ).…”

Musculoskeletal symptoms in COVID-19 and physiotherapy role: Literature review and case study

“…This condition may develop from coagulopathy, a critical illness of the virus, medications such as cortisone, direct infection of bone marrow macrophages, an autoimmune reaction with inflammation, oxidative stress, or hypoxia. [22][23][24]…”

Bone fragility: conceptual framework, therapeutic implications, and COVID-19-related issues

“…In patients after recovery from severe acute respiratory syndrome (SARS), osteonecrosis and other bone changes with reduced bone density were observed, 130 which were partly but not fully explained by corticosteroid treatment, the severity of infection, or several comorbidities that markedly increase the production of inflammatory mediators. 131 Significantly higher serum concentrations of pro- and anti-inflammatory cytokines, including IL-6, tumor necrosis factor-α, and IL-10, suggest that disease severity may be associated with a ‘cytokine storm’. Several cytokines, in particular RANKL, play a fundamental role in osteoclastogenesis in physiological and pathological conditions.…”