The impact of the COVID-19 pandemic on osteoporotic fractures: a systematic review and meta-analysis.

Peiyuan Tang; Ruijie Xiao; Wenfeng Xiao; Ting Wen; Yusheng Li; Bangbao Lu; Xucheng Yang

doi:10.1080/07853890.2025.2604391

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The impact of the COVID-19 pandemic on osteoporotic fractures: a systematic review and meta-analysis.

Peiyuan Tang·Ruijie Xiao·Wenfeng Xiao·Ting Wen·Yusheng Li·Bangbao Lu·Xucheng Yang

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Abstract

BACKGROUND: Recent reports suggest that the COVID-19 pandemic and associated lockdowns may have influenced the epidemiology of osteoporotic fractures, but results vary across regions and fracture types. The aim of this study was to provide evidence-based insights into the impact of the pandemic on osteoporotic fracture incidence. METHODS: We searched four databases (PubMed, Embase, Cochrane Library, and Web of Science) up to August 2025 for observational or retrospective studies comparing osteoporotic fracture incidence during the COVID-19 pandemic (2020) with the pre-pandemic period (2019). The primary outcome of interest was the change in fracture incidence, analysed using risk ratios (RR) with 95% confidence intervals (CI) in Review Manager 5.4. Subgroup analyses were performed by sex, geographic region, and fracture type. RESULTS: Nine studies meeting the inclusion criteria were analysed. Overall, "all types" of osteoporotic fractures showed a significant decrease during the pandemic (RR = 0.85, 95% CI 0.80-0.91, p < 0.0001). Specifically, forearm fractures decreased significantly (RR = 0.87, 95% CI 0.79-0.96, p = 0.002). However, for the most clinically significant fractures, no statistically significant global change was found for hip fractures (RR = 0.93, 95% CI 0.76-1.15, p = 0.14) or vertebral fractures (RR = 1.35, 95% CI 0.85-2.15, p = 0.20). In regional subgroup analysis, hip fracture incidence decreased significantly in South America (RR = 0.79, p = 0.0004) and in both males and females, but no significant change was observed in Europe (RR = 0.92, 95% CI 0.81-1.04, p = 0.17). CONCLUSION: During the COVID-19 pandemic, there was a decrease in the incidence of minor fractures, such as those of the forearm, likely due to reduced outdoor activity. However, the incidence of major osteoporotic fractures (hip and vertebral) remained stable globally, with significant reductions observed only in specific regions like South America.

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Humans COVID-19 Osteoporotic Fractures Incidence SARS-CoV-2 Male Female Pandemics Spinal Fractures Hip Fractures fracture meta-analysis osteoporosis Journal Article Systematic Review Meta-Analysis Research Support, Non-U.S. Gov't

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Peiyuan Tang, Ruijie Xiao, Wenfeng Xiao, Ting Wen, Yusheng Li, Bangbao Lu, Xucheng Yang. 2025-12-22. The impact of the COVID-19 pandemic on osteoporotic fractures: a systematic review and meta-analysis.. https://doi.org/10.1080/07853890.2025.2604391

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COVID-19 subject Female subject Humans subject Incidence subject Journal Article subject Journal Article; Systematic Review; Meta-Analysis; Research Support, Non-U.S. Gov't resource Male subject Meta-Analysis subject Osteoporotic Fractures subject Systematic reviews study fracture subject

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