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Multicenter Study
. 2024 Jul:184:117095.
doi: 10.1016/j.bone.2024.117095. Epub 2024 Apr 8.

CT-derived vertebral bone mineral density is a useful biomarker to predict COVID-19 outcome

Shuhei Azekawa  1 , Tomoki Maetani  2 , Shotaro Chubachi  3 , Takanori Asakura  4 , Naoya Tanabe  2 , Yusuke Shiraishi  2 , Ho Namkoong  5 , Hiromu Tanaka  1 , Takashi Shimada  1 , Takahiro Fukushima  1 , Shiro Otake  1 , Kensuke Nakagawara  1 , Mayuko Watase  1 , Hideki Terai  1 , Mamoru Sasaki  6 , Soichiro Ueda  6 , Yukari Kato  7 , Norihiro Harada  7 , Shoji Suzuki  8 , Shuichi Yoshida  8 , Hiroki Tateno  8 , Yoshitake Yamada  9 , Masahiro Jinzaki  9 , Toyohiro Hirai  10 , Yukinori Okada  11 , Ryuji Koike  12 , Makoto Ishii  13 , Akinori Kimura  14 , Seiya Imoto  15 , Satoru Miyano  16 , Seishi Ogawa  17 , Takanori Kanai  18 , Koichi Fukunaga  1
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Free article
Multicenter Study

CT-derived vertebral bone mineral density is a useful biomarker to predict COVID-19 outcome

Shuhei Azekawa et al. Bone. 2024 Jul.
Free article

Abstract

The low vertebral bone computed tomography (CT) Hounsfield unit values measured on CT scans reflect low bone mineral density (BMD) and are known as diagnostic indicators for osteoporosis. The potential prognostic significance of low BMD defined by vertebral bone CT values for the coronavirus disease 2019 (COVID-19) remains unclear. This study aimed to assess the impact of BMD on the clinical outcome in Japanese patients with COVID-19 and evaluate the association between BMD and critical outcomes, such as high-flow nasal cannula, non-invasive and invasive positive pressure ventilation, extracorporeal membrane oxygenation, or death. We examined the effects of COVID-19 severity on the change of BMD over time. This multicenter retrospective cohort study enrolled 1132 inpatients with COVID-19 from the Japan COVID-19 Task Force database between February 2020 and September 2022. The bone CT values of the 4th, 7th, and 10th thoracic vertebrae were measured from chest CT images. The average of these values was defined as BMD. Furthermore, a comparative analysis was conducted between the BMD on admission and its value 3 months later. The low BMD group had a higher proportion of critical outcomes than did the high BMD group. In a subanalysis stratifying patients by epidemic wave according to onset time, critical outcomes were higher in the low BMD group in the 1st-4th waves. Multivariable logistic analysis of previously reported factors associated with COVID-19 severity revealed that low BMD, chronic kidney disease, and diabetes were independently associated with critical outcomes. At 3 months post-infection, patients with oxygen demand during hospitalization showed markedly decreased BMD than did those on admission. Low BMD in patients with COVID-19 may help predict severe disease after the disease onset. BMD may decrease over time in patients with severe COVID-19, and the impact on sequelae symptoms should be investigated in the future.

Keywords: Biomarkers; Bone density; Post-acute COVID-19 syndrome; SARS-CoV-2; X-ray computed tomography.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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