• Antonios A Koutalos, Alexandros Koskiniotis, Christos Rountas, Efstathios Konstantinou, Sarah Georgiadou, Aggelos Stefos, Nikolaos K Gatselis, George N Dalekos, and Konstantinos N Malizos.
• Department of Orthopaedic Surgery and Musculoskeletal Trauma, General University Hospital of Larissa, Greece.
• Eur. J. Intern. Med. 2024 May 1; 123: 127131127-131.

Background & AimsDuring the pandemic, steroids use at various dosages and durations for the treatment of COVID-19 patients, especially in hospitalized patients, was a common and effective strategy. However, steroid administration is associated with osteonecrosis as an adverse event. The aim of the study was to examine the prevalence of skeleton osteonecrosis in COVID-19 patients treated with or without steroids.MethodsEighty randomly selected hospitalized COVID-19 patients were analyzed, of which 40 were managed with a published protocol including steroids and 40 did not receive steroids. Demographics and laboratory measurements including white blood cells count, C-reactive protein and ferritin were retrieved from the medical records. All patients underwent magnetic resonance imaging of the hips, shoulders, and knees. Subsequently, all patients were clinically examined and Oxford hip score (OHS) and EuroQol- 5 Dimension (EQ-5D-5 L) were documented.ResultsThree patients (3/40; 7.5 %) treated with steroids were diagnosed with femoral head osteonecrosis. None of the patients in the non-steroid-treated group developed osteonecrosis. There were no differences between the two groups regarding OHS and EQ-5D-5 L. Patients with osteonecrosis had higher ferritin levels, received higher doses of corticosteroids (median dose 2200 mg), and had longer hospitalization.ConclusionsCOVID-19-related therapy with steroids resulted in lower prevalence of osteonecrosis than that previously recorded in patients with severe acute respiratory syndrome caused by coronavirus-type-1. However, this risk seems not negligible and therefore, high clinical suspicion for early diagnosis is warranted, given the fact that a great proportion of hospitalized patients received steroids during the COVID-19 pandemic.Copyright © 2024 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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