Bone death: All you need to know

As part of new complications among Covid-recovered patients, doctors find bone death to be a condition of concern
Dr S Dilip Chand Raja, Bone, Joint and Spine Surgeon.
Dr S Dilip Chand Raja, Bone, Joint and Spine Surgeon.

CHENNAI: As the country is slowly recovering from the second wave of the pandemic, preparations are on for the third wave. However, as part of the newer complications developing among the Covid-recovered patients, doctors across the country have found Avascular Necrosis (AVN) or bone death to be a condition of concern. Express caught up with Dr S Dilip Chand Raja; Bone, Joint and Spine Surgeon at Fortis Hospital, Vadapalani in Chennai. He explains in detail the condition:

In several States, bone death or Avascular Necrosis is being recorded as a post-Covid ailment. What is this condition?

There are reports of this case emerging in a few States as a result of Covid complications. Avascular means without blood supply and Necrosis means cell death. Together, it means cell death occurring in the bone because of reduction in blood supply. This is not a new disease. Hip bones are more prone to this due to a poor supply of blood. Before Covid, this case was found due to smoking, alcoholism, and steroid use linked to other conditions. Now, due to excess steroid use during Covid treatment, we witness reports of this condition.

What are the symptoms that people need to be on the lookout for?

The patient may have very subtle symptoms like hip pain, groin pain, and knee pain. The general advice would be, if you are recovering from Covid and if you have a history of steroid use, it is better to get evaluated by a bone and joint specialist. Early diagnosis holds the key.

Reports say this is due to excessive use of steroids during Covid treatment. Is it caused by the use of steroids?

Steroids alter the fat metabolism of the body. So, fat droplets get accumulated in the blood vessel preventing the blood supply, resulting in bone cell death. So, once the number of cells dwindles in quantity and quality, the joint surface slowly collapses and results in arthritis. Steroids are life-saving drugs, but we must not use them in mild Covid cases. In cases where the life is at stake, steroids must be used. The longevity and amount of steroids used must be monitored. Incidents of AVN are 21.3 per cent if the cumulative usage of steroids exceeds 5 grams. Usually, the dosage doesn’t cross 3 grams in Covid pneumonia cases. The ICU staff and pulmonologist should try to limit the usage if possible.

What is the ideal time to get admitted, and what are the consequences of this illness if treatment is delayed?

After a person recovers from Covid, if the symptoms start somewhere from three weeks to three months, the patient should seek out treatment. Unfortunately, subtle cases may present even after one year. Approximately, three to four months is the period for diagnosis if you have persistent hip and joint pain. If you miss the period and if your disease proceeds to arthritis, it may then require surgery.

How is the illness treated and what is the medication involved. How long is the treatment duration?

The theory is that we have to improve the blood supply and prevent death of bone cells. We use vasodilators and also alter the lipid profiles. The third treatment procedure is bisphosphonate therapy using drugs. The third procedure is time-tested and has yielded good results, by delaying or negating the need for surgery.

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Is there a way to prevent this condition?

Underlying factors such as smoking and alcoholism, along with steroid use, is a multi-pronged cause for AVN. If you have suffered from Covid and went through long-term steroid-use, it is vital to avoid smoking and alcohol.

What are the comorbidities linked with the condition and which is the vulnerable age-group?

This is not an infection. It is a condition. Diabetes and hypertension may alter the blood flow in the body. All associated patients must be cautious.

What’s your concluding appeal to the public?

Please don’t use steroids indiscriminately in mild Covid cases. If you have hip or thigh pain persistently during recovery, visit a facility and take an MRI. Early diagnosis can be treated by medication successfully. Finally, smoking and alcoholism must be avoided at all costs.

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