Musculoskeletal Complications of COVID-19

COVID-19, initially characterised by respiratory involvement, is now recognised to exert profound effects on the musculoskeletal system. Patients frequently report myalgia, muscle weakness and fatigue during acute infection and in post-acute sequelae. Severe cases may develop rhabdomyolysis, characterised by rapid muscle breakdown and risk of acute kidney injury. In parallel, systemic inflammation, viral-mediated disruption of the RANK-RANKL pathway and prolonged immobilisation contribute to accelerated bone resorption, reduced bone mineral density and heightened fracture risk. Arthralgia and paraspinal myositis have been observed, underscoring the heterogeneous presentation of musculoskeletal involvement. Long-term changes in body composition, including loss of lean mass and gain in fat mass, further compound functional impairment. These complications bear significant implications for rehabilitation, surgical care and public health, particularly among elderly or comorbid individuals. Multidisciplinary approaches integrating biomarkers, imaging and clinical assessment are essential to identify at-risk patients, mitigate tissue loss and restore mobility.

Research from Nature Portfolio

In an established hamster model of SARS-CoV-2 infection, investigators demonstrated multifocal loss of trabecular bone in long bones and vertebrae. Viral challenge induced dysregulation of pro-inflammatory cytokines that directly promoted osteoclast differentiation and triggered a secondary inflammatory cascade within skeletal tissues. These findings reveal a previously underappreciated mechanism of pathological bone loss driven by cytokine-mediated osteoclastogenesis and suggest the potential utility of prophylactic or therapeutic antiresorptive strategies in COVID-19 survivors.

Musculoskeletal Complications of COVID-19 publication trend

The graph below shows the total number of articles in musculoskeletal complications of covid-19 across all publications each year (not limited to Nature Index journals).

Technical terms

Myalgia: muscle pain experienced during or after infection.

Rhabdomyolysis: breakdown of skeletal muscle releasing intracellular proteins into the bloodstream.

Osteoclast: cell responsible for bone resorption.

Osteoblast: cell responsible for bone formation and mineralisation.

RANKL/OPG ratio: balance between factors promoting and inhibiting osteoclast activity.

Cytokine storm: overwhelming release of pro-inflammatory cytokines with systemic effects.

Bone mineral density (BMD): quantitative measure of bone mass used to assess fracture risk.

References

1. Effects of COVID-19 on bone fragility: a new perspective from osteoimmunological biomarkers. Frontiers in Immunology (2024).
2. SARS-CoV-2 and its Multifaceted Impact on Bone Health: Mechanisms and Clinical Evidence. Current Osteoporosis Reports (2024).
3. COVID-19-associated rhabdomyolysis: A scoping review. International Journal of Infectious Diseases (2023).
4. The Long-Term Effect of COVID-19 Infection on Body Composition. Nutrients (2024).
5. SARS-CoV-2 infection induces inflammatory bone loss in golden Syrian hamsters. Nature Communications (2022).
6. Paraspinal Myositis in Patients with COVID-19 Infection. American Journal of Neuroradiology (2020).