'Bone Death', A Post-COVID Complication, Sees An Uptick, Doctors Worried

As India gets back on its feet post the devastating second wave of COVID-19, doctors are dealing with an uptick in cases of "bone death," a post-COVID complication.

Multiple cases of "bone death," medically known as avascular necrosis, have been reported in the cities of Mumbai and Delhi. Doctors fear more such cases could surface in the coming days among those who took steroid treatment for COVID-19, reports Hindustan Times.

According to Mayo Clinic, avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to tiny breaks in bone tissue, which can lead to the bone's eventual collapse. It may affect one bone, several bones at one time, or different bones at different times. Though anyone can be affected, the condition is mostly seen in people between the ages of 30 and 50.

In India, the first reported cases were among three doctors. Dr. Sanjay Agarwala, medical director of Hinduja Hospital, told The Times Of India that the three doctors developed necrosis two months after they were treated for COVID. "These patients developed pain in their femur bone (the highest part of the thigh bone) and, since they were doctors, they recognized the symptoms and rushed for treatment," he added. Dr. Agarwala's research paper on "Avascular Necrosis As A Part Of Long Covid-19" was published in British Medical Journal on Saturday.

More cases are now being reported elsewhere. "At our daily outpatient clinic, we see one or two fresh cases of avascular necrosis among post-Covid patients," Prof Dr. S Mohanty of Mumbai-based KEM Hospital told The Times Of India. The report also quoted another doctor from the city of Nagpur, who claims to have treated up to 40 patients suffering from the condition.

Doctors think it is the overuse of steroids during the COVID treatment, which resulted in this unnatural bone damage. In the study, Agarwala mentions that the "large-scale use of life-saving corticosteroids" in COVID-19 patients will result in a "resurgence of AVN cases." While there may be other causes for bone death, the current cases are mostly steroid-induced.

Though the Indian government has no solid data on the cases, officials are taking stock of the situation. Dr. Rahul Pandit, an intensivist who is a member of the COVID-19 task force, told the news outlet that he is on the lookout for bone death cases.

"I expect cases within a month or two as AVN usually occurs five to six months after steroid use. Our second Covid wave’s peak was in April when steroids were liberally used to treat patients, so we may see it soon," Dr. Pandit added.

India recently witnessed a surge in cases of mucormycosis or black fungus, a type of fungal infection with a very high mortality rate. Doctors pegged the number of black fungus between 5,424 and 8,848 across India until May. Normally it records fewer than 20 cases a year. This too was attributed to the excessive use of steroids on COVID-19 patients.