Avascular necrosis or bone death is not an uncommon condition, but has raised concerns among COVID recovered patients. MUSBA HASHMI speaks with doctors to tell you more

Be it the continuous mutations or the different post-recovery complications, the sheer novelty of COVID-19 is hitting the experts worldwide like a thunderbolt.

This time, it is the bone death that have raised concerns among both doctors and patients. It’s a condition in which bone tissues  start to die gradually.

Dr Ishwar Bohra, Senior Consultant, Joint Replacement Surgeon, BLK Hospital, New Delhi, tells you that it is not an uncommon disease.

“Cases of avascular necrosis (AVN) are gradually being reported from some regions in India. It’s not an uncommon disease and is called bone death in layman’s language. In this condition, the bone tissues start to die. It happens so because the blood supply to the bone gets obliterated,” Bohra tells you.

This is not a new disease, prior to COVID, these cases were found to be due to steroid use associated with smoking, alcohol and other conditions. “Now, due to the overuse of steroids during COVID treatment, we are seeing reports of this condition,” Dr Shuchin Bajaj, Founder Director, Ujala Cygnus Group of Hospitals, tells you.

Though not deadly like the black fungus, it affects the bone and joint and causes crippling pain. “COVID survivors are advised to watch out for pain around their hips or thighs,” Bohra says.

Dr Shubhang Aggarwal, Orthopaedic & Robotic Joint Replacement Surgeon, NHS Hospital Jalandhar, says if not managed properly, the disease can prove to be another deadly post-COVID complication.

“This new emerging condition of bone in COVID recovered patients is medically known as avascular necrosis and if not managed well it could be another devastating post-COVID complication,” he says.

The use of steroids during the treatment of COVID-19, which is a double edged sword, is the suspect behind this unnatural bone damage.

“The excessive use of steroids causes marrow odema at bone ends and that cuts off its own blood supply. While AVN otherwise also presents after high dose steroids, the cases being reported now are definitely more in frequency and they seem to be induced by steroids,” Aggarwal tells you.

He adds that patients, who have been given steroids for improved lung function affected due to COVID-19, are more prone to get AVN of the hip.

While doctors advise COVID recovered patients to keep an eye on joint pain, it doesn’t mean that every slight pain is because of AVN.

“AVN is not something that one needs to keep thinking of for every unexplained bone pain. One should be clear that every pain is not AVN. The pain can sometimes be attributed to a sprain or injury as well. Hence, it is important to consult your doctor before drawing conclusions,” Aggarwal says.

But, if the pain persists, then patients are advised to undergo an MRI which will detect whether it is a case of bone death or not.

“The treatment of AVN aims at improving the blood supply and prevent the death of bone cells. We use vasodilators and also alter the lipid profile. Another treatment procedure is bisphosphonate therapy using drugs,” Bajaj tells you.

As this disease advances slowly, the patient might not have any symptoms in the early stages, But, as the condition worsens, it might lead to persistent pain in joints which includes hip, knee, shoulder, hand, or feet.

“Diabetic people or those who are severely immuno-compromised should be extra careful. If needed, the doctor can advise for a diagnosis using imaging techniques as the first line of treatment. The disease is treatable and curable and surgery is required at a very advanced stage,” says Bohra.

A word of caution. If you suffered from COVID and have gone through prolonged steroid-use, it is important to avoid smoking and consuming alcohol.

“Please do not use steroids indiscriminately in mild COVID cases. If you have persistent hip or thigh pain while you recover, go to a hospital and have an MRI. Early diagnosis can be successfully treated by medication. Lastly, smoking and alcohol should be avoided at all costs,” Bajaj advises.