Mumbai | Jagran News Desk: Death of bone tissues or avascular necrosis, typically known as ‘bone death’, has been reported in three patients in Mumbai. All three were aged below 40 and were considered ‘long COVID-19 patients’, that is, they took more than usual to test negative after getting infected by COVID-19. They reportedly developed necrosis between 45 days to 58 days after COVID-19 treatment.

Doctors fear that Avascular Necrosis (AVN) or ‘bone death’ could be next devastating post-COVID-19 condition, two months after country started reporting the cases of mucormycosis (Black Fungus), prompting many states to declare it an epidemic.

What happens during ‘death of bone’ or avascular necrosis?

According to Johns Hopkins University, avascular necrosis results from temporary or permanent loss of blood supply to the bone. During initial phase, the loss of blood supply is temporary that goes on to become permanent in later stages. Once the blood supply is stopped, the bone tissue dies and the bone in the affected area ends up collapsing, giving it the name, ‘death of bone’ or ‘bone death’. If such necrosis takes place near a joint, the joint may collapse leading to permanent disability.

Dr Sanjaya Agarwala, Medical Director, Hinduja Hospital told The Times of India that the patients treated for bone necrosis were doctors themselves and therefore were able to rush to hospital in time at initial onset of symptoms.

“These patients developed pain in their femur bone (the highest part of the thigh bone) and, since they were doctors, they recognised the symptoms and rushed for treatment,’’ Dr Agarwala said.

Avascular Necrosis or Bone of Death: Symptoms

According to Johns Hopkins University, the symptoms of Avascular Necrosis may appear like other medical conditions or bone problems. They include:

  • Minimal early joint pain

  • Increased joint pain as bone and joint begin to collapse

  • Limited range of motion due to pain

AVN amid COVID-19: What causes ‘Death of bone’?

Death of bone or avascular necrosis is held to be caused due to “large scale use of life-saving corticosteroids,” according to Dr Agarwala of Mumbai’s PD Hinduja hospital.

A research paper authored by top Orthopaedicians of PD Hinduja hospital found the occurrence of ‘death of bone’ disease with a low mean steroid dosage of 758 mg with a minimum dose of 400 mg.

“The patient developed AVN very early with a mean range of 58 days after COVID-19 diagnosis,” the paper adds.

Early diagnosis ‘crucial’

In the research paper titled ‘Avascular necrosis as a part of long COVID-19’, authored by top Orthopaedic doctors of PD Hinduja Hospital, it is said that if diagnosed early, 92 to 97 per cent patients do not require surgery and can be managed by a treatment called bisphosphonate therapy.

Once the situation deteriorates, joint replacement (or arthroplasty) remains the “mainstay” of the treatment, according to Orthopaedics at Mumbai’s PD Hinduja hospital.

‘No standardised protocol’ to treat bone of death, doctors warn

Doctors in the above research paper write that though there are options available to treat avascular necrosis, “no standardized protocol exists” to treat the disease. In absence of this, doctors quote evidence about the role of bisphosphonates in the management of disease.

(Disclaimer: The article is purely informative based on the researches and several studies. However, English Jagran does not independently vouch for this report)

Posted By: Mukul Sharma