Avoid common mistakes on your manuscript.
To the Editor,
Corticosteroid therapy is widely used to treat patients with COVID-19 in China [1, 2], but its efficacy remains controversial.
The side effects and long-term complications of corticosteroids, especially in the skeletal system, where corticosteroids can cause osteonecrosis and osteoporosis, should be considered by doctors and patients.
Corticosteroids are widely used in the treatment of patients with SARS and MERS. A meta-analysis of data from 1137 patients with SARS showed clear evidence of a relationship between osteonecrosis and the cumulative dose and treatment duration of corticosteroids. No sex differences between male and female patients were found in the development of corticosteroid-induced osteonecrosis. The cumulative dose and treatment duration of corticosteroids are major risk factors for the development of osteonecrosis in SARS patients [3]. To date, the quality of life of some patients who survived SARS has been affected by corticosteroid-induced osteonecrosis.
Glucocorticoids can profoundly affect bone cell function and mineral metabolism, which leads to the development of low bone density and osteoporosis. Clinical studies have shown that most of this bone loss occurs during the initial periods of exposure to corticosteroids and that even a modest dosage of corticosteroids, which is generally considered to be in the range of physiological replacement, may increase the risk of fractures [4]. Studies of SARS patients treated with corticosteroids showed that factors affecting bone mineral density include age, the sum of corticosteroid doses and the duration of treatment [5].
Therefore, to prevent the occurrence of side effects, some measures should be taken before and after COVID-19 patients are treated with corticosteroids. First, clinicians should question the patient to determine if there is any discomfort, such as joint pain, and use magnetic resonance imaging (MRI) to detect osteonecrosis, especially necrosis of the femoral head, if necessary. Second, the patient’s blood calcium, phosphine, 25-hydroxyvitamin D, parathyroid hormone (PTH), and bone density should be monitored. Third, adequate dietary intake of calcium (1000 mg per day) and vitamin D (600 to 800 IU) and other appropriate treatments according to the patient’s condition are routinely encouraged to prevent osteoporosis in patients beginning corticosteroid treatment [4].
References
Zha L, Li S, Pan L, Tefsen B, Li Y, French N, Chen L, Yang G, Villanueva EV (2020) Corticosteroid treatment of patients with coronavirus disease 2019 (COVID-19). Med J Aust 212:416–420. https://doi.org/10.5694/mja2.50577
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan. China Jama 323:1061. https://doi.org/10.1001/jama.2020.1585
Zhao R, Wang H, Wang X, Feng F (2017) Steroid therapy and the risk of osteonecrosis in SARS patients: a dose-response meta-analysis. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 28(3):1027–1034. https://doi.org/10.1007/s00198-016-3824-z
Buckley L, Humphrey MB (2018) Glucocorticoid-induced osteoporosis. N Engl J Med 379(26):2547–2556. https://doi.org/10.1056/NEJMcp1800214
Li YM, Wang SX, Gao HS, Wang JG, Wei CS, Chen LM, Hui WL, Yuan SL, Jiao ZS, Yang Z, Su B (2004) Factors of avascular necrosis of femoral head and osteoporosis in SARS patients' convalescence. Zhonghua Yi Xue Za Zhi 84(16):1348–1353
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
No relevant disclosures.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Tang, J. What can we learn about corticosteroid therapy as a treatment for COVID-19?. Osteoporos Int 31, 1595 (2020). https://doi.org/10.1007/s00198-020-05487-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-020-05487-w