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“Bone death” affecting COVID-19 survivors

India is gradually recovering from its second wave of COVID-19. However, the health system is reeling as other conditions appear to be rising in its wake. Adding to the list of post-COVID-19 complications is avascular necrosis — commonly, and ominously, being referred to as “bone death”.

osteonecrosis, bone death
Nuclear magnetic resonance of avascular necrosis of left femoral head. Attribution, Wikimedia Commons Author: Jmarchn

Other diseases become prevalent in the wake of India’s second wave of COVID-19. Foremost among these was mucormycosis — or black fungus. Black fungus, while normally not a cause for concern, caused severe infections in those who were immunocompromised through COVID-19. In addition, use of steroids to reduce inflammation within the lungs reduced immune response further, causing black fungus to more readily infect individuals.

Thus far, there have only been three reported cases of bone death in COVID-19 survivors, all of which have been reported in Mumbai. While this may seem as though the situation could be all but disregarded, doctors have warned that they expect cases to rise in the near future. 

The condition is also known as osteonecrosis. It is caused when blood supply to bone tissue is reduced or cut off. While the link to COVID-19 may not seem apparent, the cases of black fungus pointed doctors in the right direction to understanding the cause. Osteonecrosis is often a side effect of prolonged steroid treatment which, given its use in COVID-19 treatment, exposes many to the risk of this disorder.

Other issues can increase the risk factor of osteonecrosis. Among these are injuries such as breaking of a bone in which the surrounding tissue (including blood vessels) is damaged, alcoholism, sickle cell anemia, Gaucher’s disease, cancer treatment involving radiotherapy, and obesity.

Of the list of additional risk factors, some have been marked by doctors as being issues an individual can work to alter. They have advised that alcohol intake be limited, smoking stopped, and weight reduced in those noted as affected by obesity. Given the prevalence of many of these issues in India, a vast number of people recovering from COVID-19 could be at risk.

India’s health system is already overburdened. Though the second wave of COVID-19 may be in remission, there have been warnings of the potential of a third wave. Any additional burden on the hospital system, particularly those that are linked to COVID-19 cases, could threaten to overwhelm it.


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