Endocrine Abstracts

Morphometric-Vertebral Fractures (VFs), which were widely demonstrated to reduce overall-survival and respiratory function in the general population, have been recently reported to be highly prevalent in COVID-19 patients. Emerging data show negative respiratory sequelae at long-term follow-up in COVID-19 survivors. The aim of this study is to evaluate the VFs influence on respiratory function of COVID-19 survivors. We included COVID-19 patients admitted at San Raffaele-Hospital and re-evaluated at the San Raffaele-Outpatient Follow-Up Clinic. Lateral chest-X-rays on admission in emergency-department were obtained and pulmonary function tests (PFTs) were performed at six-months of follow-up. VFs were detected using a qualitative and semiquantitative assessment and PFTs were obtained by Jaeger-MasterScreen-AnalyzerUnit. Fifty patients were included in the study. Median age was 66 years, and 33 (66%) patients were males. VFs were detected in 16 (32%) patients. No differences between fractured and non-fractured groups regarding age, sex and comorbidities were observed. A Radiological-Assessment-of-Lung-Edema (RALE) score, assessing the severity of pulmonary opacities, was available for 30 patients with a median value of 5.5. Although no differences were observed in RALE score between VFs+ and VFs- patients (5 vs 6, P=0.69), those with VFs were characterized by a significant lower SpO2/FiO2 ratio, higher CRP levels, and required hospitalization more frequently (100% vs 73%, P=0.04). No differences were found regarding ICU-admission. At follow-up, patients with VFs were characterized by significant lower Forced-Vital-Capacity (FVC; 2.9 vs 3.6 L, P=0.006; 85% vs 110% predicted, P=0.001), Forced-Expiratory Volume-1st-second (FEV1; 2.2 vs 2.8 L, P=0.005; 92% vs 110%; P=0.001). Moreover, a lower diffusing-capacity-for-carbon-monoxide (DLCOSB; 5.83 vs 6.98 mmol/min/kpa, P=0.036, 59% vs 86.3%, P=0.043) as well as Total Lung-Capacity (TLC; 4.9 vs 6.1 L, P=0.027; 84% vs 98%; P=0.04) were found in patients with VFs compared to those without. In linear regression analyses, the Spine-deformity-index (SDI) was significantly correlated negatively with FVC% (P=0.02) and positively with FEV1/FVC (P=0.01), and negative trends with FEV1% and DLCOSB% were observed (P=0.12, P=0.12, respectively). VFs found on hospital admission appear to be independent predictors of medium term impaired respiratory-function of COVID-19 survivors which may significantly influence their recovery. Therefore, our findings suggest that a VFs assessment at baseline may help in identifying patients needing a more intensive respiratory follow-up after discharge. Patients showing persistent respiratory symptoms and functional impairment without evidence of pulmonary disease may benefit from VFs assessment in order to preventing the vicious-circle of further fractures and respiratory deterioration.