In December, 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei province, China, and COVID-19 has become a threat to global public health.1
Use of corticosteroid-based therapy to reduce inflammatory-induced lung injury has been described for patients with severe COVID-19,2, 3 similar to the use of corticosteroids to treat severe acute respiratory syndrome (SARS) during the SARS outbreak in 2003.4 However, improper use of systemic corticosteroids can increase the risk of osteonecrosis of the femoral head (ONFH).
In a retrospective study of 539 patients with SARS who received corticosteroid therapy,5 the incidence of steroid-induced ONFH was 24%, and increased incidence of steroid-induced ONFH was associated with total corticosteroid dose and the use of more than one type of corticosteroid. Improper or delayed treatment of steroid-induced ONFH can cause hip pain, claudication, and even disability of the lower limbs.
Overall, we call for caution in the use of corticosteroids for COVID-19 and do not recommend this as a routine treatment. To prevent steroidinduced ONFH, corticosteroids should be considered only for patients undergoing septic shock, or in critical cases.6, 7 Corticosteroids should be minimised in dose and duration, and the use of multiple types should be avoided. We believe that bisphosphonates and vitamin E should be prescribed to patients who are undergoing corticosteroid treatment; anticoagulants, vasodilators, and traditional Chinese medicine could also be considered.8, 9, 10 Close follow-up should be conducted after discharged, with MRI as the best option for early detection of ONFH. Physical therapy and combined pharmacotherapy have been recommended for patients with early-stage steroid-induced ONFH.11
Acknowledgments
We declare no competing interests.
References
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