Acute Sarcopenia Research Articles

New horizons in hospital-associated deconditioning: a global condition of body and mind.

Hospital-associated deconditioning is a broad term, which refers non-specifically to declines in any function of the body secondary to hospitalisation. Older people, particularly those living with frailty, are known to be at greatest risk. It has historically been most commonly used as a term to describe declines in muscle mass and function (i.e. acute sarcopenia). However, declines in physical function do not occur in isolation, and it is recognised that cognitive deconditioning (defined by delayed mental processing as part of a spectrum with fulminant delirium at one end) is commonly encountered by patients in hospital. Whilst the term 'deconditioning' is descriptive, it perhaps leads to under-emphasis on the inherent organ dysfunction that is associated, and also implies some ease of reversibility. Whilst deconditioning may be reversible with early intervention strategies, the long-term effects can be devastating. In this article, we summarise the most recent research on this topic including new promising interventions and describe our recommendations for implementation of tools such as the Frailty Care Bundle.

Short-Term Multicomponent Exercise Impact on Muscle Function and Structure in Hospitalized Older at Risk of Acute Sarcopenia.

Hospitalization exacerbates sarcopenia and physical dysfunction in older adults. Whether tailored inpatient exercise prevents acute sarcopenia is unknown. This study aimed to examine the effect of a multicomponent exercise programme on muscle and physical function in hospitalized older adults. We hypothesized that participation in a brief tailored exercise regimen (i.e., 3-5 days) would attenuate muscle function and structure changes compared with usual hospital care alone. This randomized clinical trial with blinded outcome assessment was conducted from May 2018 to April 2021 at Hospital Universitario de Navarra, Spain. Participants were 130 patients aged 75 years and older admitted to an acute care geriatric unit. Patients were randomized to a tailored 3- to 5-day exercise programme (n = 64) or usual hospital care (control, n = 66) consisting of physical therapy if needed. The coprimary endpoints were between-group differences in changes in short physical performance battery (SPPB) score and usual gait velocity from hospital admission to discharge. Secondary endpoints included changes in rectus femoris echo intensity, cross-sectional area, thickness and subcutaneous and intramuscular fat by ultrasound. Among 130 randomized patients (mean [SD] age, 87.7 [4.6] years; 57 [44%] women), the exercise group increased their mean SPPB score by 0.98 points (95% CI, 0.28-1.69 points) and gait velocity by 0.09 m/s (95% CI, 0.03-0.15 m/s) more than controls (both p < 0.01). No between-group differences were observed in any ultrasound muscle outcomes. There were no study-related adverse events. Three to 5 days of tailored multicomponent exercise provided functional benefits but did not alter muscle or fat architecture compared with usual hospital care alone among vulnerable older patients. Brief exercise may help prevent acute sarcopenia during hospitalization. ClinicalTrials.gov identifier: NCT04600453.

Acute Sarcopenia: Mechanisms and Management.

Acute sarcopenia refers to the swift decline in muscle function and mass following acute events such as illness, surgery, trauma, or burns that presents significant challenges in hospitalized older adults. narrative review to describe the mechanisms and management of acute sarcopenia. The prevalence of acute sarcopenia ranges from 28% to 69%, likely underdiagnosed due to the absence of muscle mass and function assessments in most clinical settings. Systemic inflammation, immune-endocrine dysregulation, and anabolic resistance are identified as key pathophysiological factors. Interventions include early mobilization, resistance exercise, neuromuscular electrical stimulation, and nutritional strategies such as protein supplementation, leucine, β-hydroxy-β-methyl-butyrate, omega-3 fatty acids, and creatine monohydrate. Pharmaceuticals show variable efficacy. Future research should prioritize serial monitoring of muscle parameters, identification of predictive biomarkers, and the involvement of multidisciplinary teams from hospital admission to address sarcopenia. Early and targeted interventions are crucial to improve outcomes and prevent long-term disability associated with acute sarcopenia.

Assessment of Acute Sarcopenia With Muscle Ultrasound in Hospitalized Older Patients: A Prospective Pilot Study

Assessment of Acute Sarcopenia With Muscle Ultrasound in Hospitalized Older Patients: A Prospective Pilot Study

Risk Factors Associated with Acute Sarcopenia in Patients Hospitalized with COVID-19.

The COVID-19 pandemic is an extraordinary global emergency. The pandemic has changed profoundly people's lifestyles. This resulted in reductions in physical activity and changes in dietary intakes that have the potential to accelerate sarcopenia. The aim of this study was to evaluate the risk factors associated with acute sarcopenia in patients hospitalized with COVID-19. This was a cross-sectional study conducted from January/2021 to March/2022 in a private hospital in Cuiabá/MT, central region of Brazil. The main variable was the prevalence of acute sarcopenia among adults hospitalized with COVID19. Patients were assessed for acute sarcopenia using the SARC-F ≥4 questionnaire (strength, assistance with walking, rise from a chair, climb stairs, and falls), grip strength (<20 kg (female) and <35 kg (male)), and calf circumference (<33 cm (female) and <34 cm (male)). In all, 213 patients aged 57.4 ± 15.4 years, 63.8% male, were studied. Thirty-four (16.0%) patients were diagnosed with acute sarcopenia. Advanced age (older people) and the percentage of weight lost ≥3% before hospitalization were independent risk factors for acute sarcopenia in hospitalized patients with COVID-19. Acute sarcopenia was present in 16% of patients. Advanced age and percentage of weight lost ≥3% were independent risk factors for acute sarcopenia in patients hospitalized with COVID-19.

Establishing Predictors of Acute Sarcopenia: A Proof-Of-Concept Study Utilising Network Analysis.

Dynamic changes in sarcopenia status following stressor events are defined as acute sarcopenia; it is currently unknown how to stratify risk. Prospective observational study involving elective colorectal surgery, emergency abdominal surgery, and medical patients with infections aged ≥70 years-old. Handgrip strength, muscle quantity (ultrasound Bilateral Anterior Thigh Thickness, BATT, and Bioelectrical Impedance Analysis), and muscle quality (rectus femoris echogenicity) were measured preoperatively in the elective group, and within 48hours, 7days after, and 13weeks after admission/surgery. Serum/plasma samples were collected preoperatively (elective group) and within 48hours of admission/surgery (all groups). LASSO models adjusting for baseline sarcopenia status were performed. Seventy-nine participants were included (mean age 79.1, 39.2% female). Chronic Obstructive Pulmonary Disease (COPD) (48hours β 0.67, CI 0.59-0.75), and prescription of steroids during admission (48hours β 1.11, CI 0.98-1.24) were positively associated with sarcopenia at 7days. Delirium was negatively associated with change in BATT to 7days (7days β -0.47, CI -0.5- -0.44). COPD (Preoperative β 0.35, CI 0.12-0.58) and delirium (48hours β 0.13, CI 0.06-0.2) were positively associated with change in echogenicity to 7days in analysis including systemic biomarkers. Participants with sarcopenia at baseline had higher IL-7 concentrations during acute phase of illness (median 8.78pg/mL vs 6.52pg/mL; p=0.014). IL-1b within 48hours of admission/surgery was positively associated with sarcopenia status at 7days (β 0.24, CI 0.06-0.42). Patients most at risk of acute sarcopenia or reductions in muscle quantity and quality included those prescribed steroids, with COPD or delirium, or with heightened systemic inflammation.

Decreased Follistatin Levels as a Risk of Acute Sarcopenia Marker in Elderly

Background: Acute sarcopenia is an acute muscle loss that has been associated to the frailty and vulnerability of the elderly. Follistatin has been known as a significant marker for sarcopenia, however, studies of follistatin in humans have shown varying results and there have been no studies to date regarding the relationship between follistatin and acute sarcopenia. The aim of this study was to determine changes in follistatin levels as a risk of acute sarcopenia in elderly.Materials and methods: This study was a prospective observational study involving hospitalized elderly. The follistatin level was examined with enzyme-linked immunosorbent assay (ELISA). Meanwhile the determination of acute sarcopenia was done through the measurement of changes in hand grip strength and calf circumference parameters. The data obtained was descriptively analyzed, followed by bivariate and multivariate analysis. A p&lt;0.05 was considered significant.Results: There were 66 subjects in this study. A total of 10 subjects (15.2%) had acute sarcopenia on the 7th day of hospitalization. The cut-off point of decreased follistatin levels was 4.870 with a sensitivity of 82.1% and a specificity of 60%. There was an association between decreased follistatin levels and acute sarcopenia (p=0.01; RR: 6.90; 95% CI: 1.638-29.069). Multivariate analysis results showed that decreased follistatin levels was a significant factor that might influence the occurrence of acute sarcopenia.Conclusion: Since this study showed that decreased follistatin levels might be a risk of acute sarcopenia in the elderly, thus it could be used as a marker of acute sarcopenia, which should be further investigated.Keywords: decreased follistatin levels, acute sarcopenia, elderly

Acute muscle loss and early effects of COVID-19 on skeletal muscle in adult patients: A retrospective cohort study

ObjectivesIt is known that COVID-19 has multisystemic effects. However, its early effects on muscle tissue have not been clearly elucidated. The aim of this study is to investigate early changes in the pectoral muscle in patients with COVID-19 infection. Materials and methodsThe pectoral muscle areas (PMA) and pectoral muscle index (PMI) of 139 patients diagnosed with COVID-19 were measured from chest CTs taken at the time of the first diagnosis and within 6 months after the diagnosis. The effect of the infection on the muscle area was investigated by evaluating whether there was a change between the two measurements. Lung involvement of the infection in the first CT was scored with the CT severity score (CT-SS). In addition, the effects of patients' clinics, CT-SS, length of hospital stay, and intubation history on changes in the muscle area were investigated. ResultsWhen the PMA and PMI values were compared, there was a statistically significant decrease in the values in the control CT group compared to the first diagnosis CT group. The difference was found higher in intubated patients. CT-SS was associated with a decrease in PMI. ConclusionCOVID-19 is one of the causes of acute sarcopenia. Pectoralis muscle is part of the skeletal muscle, and there may be a decrease in the muscle area in the early period of the disease.

COVID-19 related to sarcopenia: Current perspectives on etiology, clinical implications, and nutritional rehabilitation

Sarcopenia is a progressive skeletal muscle disorder characterized by reduced strength and quality. Pathophysiological mechanisms, clinical aspects, and nutritional points were related to sarcopenia in COVID-19 found in skeletal muscle during and after the disease course, which corroborated the development of adverse events. Declining physical activity, insufficient protein intake, and worsened proinflammatory response have been shown to have negative consequences on muscle protein synthesis, potentiating the risk of acute sarcopenia. Obesity sarcopenia has also been shown to worsen the prognosis of patients with SARS-CoV-2. Nutritional rehabilitation is used to prevent or minimize the development of acute sarcopenia. Dietary recommendations include increased energy supply and protein intake of 1.2 to 2.0 g/kg of body weight. Evidence suggests that aging with sedentary behaviors, pathophysiological changes, and inflammation alter body composition. In addition, nutritional deficiencies are predictors and aggravators of acute sarcopenia in COVID-19.

Effect of physical activity on long COVID fatigue: an unsolved enigma.

Covid-19 disease is well documented and often the most common symptoms include myalgia and muscle fatigue. Approximately 10% of those infected complain of persistent fatigue even many months after the end of the acute phase of the disease. This gives rise to a condition different from the previous one and commonly known as 'post-acute COVID-19 syndrome' or simply Long-COVID. Although the origin of muscle fatigue is multifactorial, the state of prolonged fatigue observed in the Long-COVID syndrome suggests the existence of a possible state of atrophy or rather acute sarcopenia. Under these conditions, the use of physical activity programs can effectively counteract the state of atrophy underlying the fatigue phenomena observed. If this is also the situation during the Long-COVID, the muscular symptom should be positively influenced by the administration of programmed physical activity cycles. In fact, in patients with Long-COVID, the few published papers seem to indicate that patients who are physically active and who make an effort to engage in physical activity even during the illness have decreased duration and intensity of the illness. However, analysis of the studies in the literature also suggests that a small percentage of people with Long-COVID do not appear to benefit from the application of physical activity programs, so further studies on homogeneous samples are needed to provide a firm answer to the question: can planned physical activity help patients during the pathological course of Long-COVID?

Investigating the impact of fluid status on the ultrasound assessment of muscle quantity and quality in the diagnosis of sarcopenia – a multidimensional cross-sectional study

BackgroundSarcopenia is a clinical manifestation of adverse ageing, characterised by progressive loss of muscle mass and function. Diagnosis requires assessment of muscle quantity and quality; ultrasound represents an emerging tool for this. However, ultrasound muscle assessment may be impacted by fluid balance. This is particularly important when assessing for acute sarcopenia in hospitalised patients, where fluid disturbance often occurs. The primary aim of this study was to characterise the impact of fluid status on ultrasound muscle assessment, such that this may be accounted for in sarcopenia diagnostics.MethodsThis Multidimensional Cross-sectional study involved 80 participants, who were inpatients at QEHB, a large UK tertiary centre. Fluid status was evaluated clinically and quantified using Bioelectrical Impedance Analysis (BIA). Muscle quantity was measured using Bilateral Anterior Thigh Thickness (BATT) with Rectus Femoris (RF) echogenicity used to assesses muscle adiposity and hence provide an inverse measure of muscle quality.ResultsA significant positive correlation was found between fluid status, measured using BIA, and BATT as a measure of muscle quantity, in males (rs = 0.662, p < 0.001) and females (rs = 0.638, p < 0.001). A significant negative correlation was found between fluid status and RF echogenicity (rs=-0.448, p < 0.001).ConclusionsThese findings demonstrate associations between fluid balance and ultrasound assessment of muscle quantity and quality. Given the emerging use of ultrasound muscle assessment in sarcopenia diagnosis, there is a need to account for this in clinical practice. Future research should focus on the development of a corrective equation allowing assessment of muscle quantity and quality which account for changes in fluid status, hence aiding accurate diagnosis of sarcopenia.

Potential role of statins in treatment of acute sarcopenia

Accelerated muscle aging, known as sarcopenia, is a geriatric condition that poses significant health risks both for individuals and society. Hospitalization can trigger a sudden deterioration of sarcopenia, making it imperative to find effective interventions targeting this acute sarcopenia. Drug repurposing, which involves utilizing ‘old’ medications for new indications, could be a cost-effective and faster solution as the safety of these drugs has already been established in the old population. The authors propose that short-term use of low-dose statins may be a promising option for preventing and treating acute sarcopenia. This hypothesis is based on the mechanisms of action of statins, which demonstrate hormesis-like effects with no direct muscle-toxic effects at low doses, as well as muscle-beneficial indirect effects through other body systems such as the immune-endothelial system and the gut microbiota at low doses. Additionally, supportive observational studies suggest beneficial muscle effects in inflammatory subgroups of older people, with a safe track record of statins in older people at short-term low doses. Therefore, it is hypothesized that statins may be of potential benefit in combating acute sarcopenia.

COVID-19 in Older Patients: Assessment of Post-COVID-19 Sarcopenia

(1) Background: Acute COVID-19 infections produce alterations in the skeletal muscle, leading to acute sarcopenia, but the medium- and long-term consequences are still unknown. The aim of this study was to evaluate: (1) body composition; (2) muscle strength and the prevalence of sarcopenia; and (3) the relationship between muscle strength with symptomatic and functional evolution in older patients affected by/recovered from COVID-19; (2) Methods: A prospective, longitudinal study of patients aged ≥65 years who had suffered from COVID-19 infection between 1 March and 31 May 2020, as confirmed by PCR or subsequent seroconversion. Persistent symptoms, as well as anthropometric, clinical, and analytical characteristics, were analyzed at 3 and 12 months after infection. The degree of sarcopenia was determined by dynamometry and with SARC-F; (3) Results: 106 participants, aged 76.8 ± 7 years, were included. At 3 months postinfection, a high percentage of sarcopenic patients was found, especially among women and in those with hospitalization. At 12 months postinfection, this percentage had decreased, coinciding with a functional and symptomatic recovery, and the normalization of inflammatory parameters, especially interleukin-6 (4.7 ± 11.6 pg/mL vs. 1.5 ± 2.4 pg/mL, p < 0.05). The improvement in muscle strength was accompanied by significant weight gain (71.9 ± 12.1 kg vs. 74.7 ± 12.7 kg, p < 0.001), but not by an increase in lean mass (49.6 ± 10 vs. 49.9 ± 10, p 0.29); (4) Conclusions: Older COVID-19 survivors presented a functional, clinical, and muscular recovery 12 months postinfection. Even so, it is necessary to carry out comprehensive follow-ups and assessments that include aspects of nutrition and physical activity.

Pérdida muscular aguda y primeros efectos de la COVID-19 en el músculo esquelético de pacientes adultos: estudio de cohortes retrospectivo

ObjectivesIt is known that COVID-19 has multisystemic effects. However, its early effects on muscle tissue have not been clearly elucidated. The aim of this study is to investigate early changes in the pectoral muscle in patients with COVID-19 infection. Materials and methodsThe pectoral muscle areas (PMA) and pectoral muscle index (PMI) of 139 patients diagnosed with COVID-19 were measured from chest CTs taken at the time of the first diagnosis and within 6months after the diagnosis. The effect of the infection on the muscle area was investigated by evaluating whether there was a change between the two measurements. Lung involvement of the infection in the first CT was scored with the CT severity score (CT-SS). In addition, the effects of patients’ clinics, CT-SS, length of hospital stay, and intubation history on changes in the muscle area were investigated. ResultsWhen the PMA and PMI values were compared, there was a statistically significant decrease in the values in the control CT group compared to the first diagnosis CT group. The difference was found higher in intubated patients. CT-SS was associated with a decrease in PMI. ConclusionCOVID-19 is one of the causes of acute sarcopenia. Pectoralis muscle is part of the skeletal muscle, and there may be a decrease in the muscle area in the early period of the disease.

Acute sarcopenia and risk of new-onset diabetes in coronavirus disease 2019 patients

Acute sarcopenia and risk of new-onset diabetes in coronavirus disease 2019 patients

307 THE FEASIBILITY OF USING AN INCLINOMETER TO PROVIDE OLDER HOSPITALISED PATIENTS WITH FEEDBACK ON THEIR ACTIVITY LEVELS

Abstract Background Low levels of physical activity in older adults are well documented and have been associated with functional decline, acute sarcopenia, prolonged length of stay and higher readmission rates. Interventions to modify behaviour in hospitalised older adults include providing feedback on performance. Commercially available activity trackers and pedometers which rely on step count, are often unable to detect steps at the walking speeds found in older hospitalised patients. This study investigated the feasibility of using an inclinometer to measure the time spent by older hospitalised adults in lying and sitting versus standing and walking, and to provide feedback to patients on their active versus sedentary levels. Methods This was a feasibility study using a cross-sectional single centre design. Twelve inpatients over 70 years of age were fitted with an ActivPAL accelerometer on their thigh, which was worn continuously for 3 days. A graphic display of sedentary versus active time was provided to the participants each morning. Acceptability of wearing the device and receiving feedback was determined using a modified technology acceptance questionnaire. Results Twelve hospitalised older adults (7 female, 5 male) were included in the study, median age 74 (66-84). A modified technology questionnaire showed that 83% of participants found the ActivPAL device comfortable to wear, 100% reported that the feedback from the device was clear and understandable and 92% reported that the information enhanced their motivation for physical activity and that they would wear the device again. Conclusion This feasibility study shows that the ActivPAL is a device that can be worn in the hospital setting to provide older adults with feedback on their activity levels in order to modify behaviour and increase their levels of physical activity while in hospital.

Acute Sarcopenia in Elderly with COVID-19: An Overlooked Problem

The coronavirus Disease-19 (COVID-19) pandemic was announced in March 2020 by World Health Organization (WHO). Studies showed that the elderly had higher morbidity and mortality rates. Acute sarcopenia in the elderly with COVID-19 is an overlooked problem. Inflammation, malnutrition, immobilization, a side effect of COVID-19 treatment, depression, and hormonal dysregulation contributed to acute sarcopenia in COVID-19, especially in the elderly. Muscle quantity can be assessed with different techniques such as imaging or anthropometric measurements in diagnosing sarcopenia. Imaging such as CT scan was widely used in multiple studies. Still, anthropometric measurements are more fit in developing countries because they are widely available, safe, do not require special skills, and fit in low-resources facilities. Muscle strength can be assessed with grip strength. Acute sarcopenia was associated with immune dysregulation and cytokine storm, length of stay and readmission, and ICU admission and mechanical ventilation. These will contribute to high mortality in sarcopenic elderly with COVID-19.

Induced frailty and acute sarcopenia are overlapping consequences of hospitalisation in older adults.

Objectives:To determine the effects of hospitalisation upon frailty and sarcopenia.Methods:Prospective cohort study at single UK hospital including adults ≥70 years-old admitted for elective colorectal surgery, emergency abdominal surgery, or acute infections. Serial assessments for frailty (Fried, Frailty Index, Clinical Frailty Scale [CFS]), and sarcopenia (handgrip strength, ultrasound quadriceps and/or bioelectrical impedance analysis, and gait speed and/or Short Physical Performance Battery) were conducted at baseline, 7 days post-admission/post-operatively, and 13 weeks post-admission/post-operatively.Results:Eighty participants were included (mean age 79.2, 38.8% females). Frailty prevalence by all criteria at baseline was higher among medical compared to surgical participants. Median and estimated marginal CFS values and Fried frailty prevalence increased after 7 days, with rates returning towards baseline at 13 weeks. Sarcopenia incidence amongst those who did not have sarcopenia at baseline was 20.0%. However, some participants demonstrated improvements in sarcopenia status, and overall sarcopenia prevalence did not change. There was significant overlap between diagnoses with 37.3% meeting criteria for all four diagnoses at 7 days.Conclusions:Induced frailty and acute sarcopenia are overlapping conditions affecting older adults during hospitalisation. Rates of frailty returned towards baseline at 13 weeks, suggesting that induced frailty is reversible.

Acute skeletal muscle loss in SARS-CoV-2 infection contributes to poor clinical outcomes in COVID-19 patients.

BackgroundChronic disease causes skeletal muscle loss that contributes to morbidity and mortality. There are limited data on the impact of dynamic muscle loss on clinical outcomes in COVID‐19. We hypothesized that acute COVID‐19‐related muscle loss (acute sarcopenia) is associated with adverse outcomes.MethodsA retrospective analysis of a prospective clinical registry of COVID‐19 patients was performed in consecutive hospitalized patients with acute COVID‐19 (n = 95) and compared with non‐COVID‐19 controls (n = 19) with two temporally unique CT scans. Pectoralis muscle (PM), erector spinae muscle (ESM) and 30 day standardized per cent change in cross sectional muscle area were quantified. Primary outcomes included mortality and need for intensive care unit (ICU) admission. Multivariate linear and logistic regression were performed. Cox proportional hazard ratios were generated for ICU admission or mortality for the per cent muscle loss standardized to 30 days.ResultsThe COVID‐19 CT scan cohort (n = 95) had an average age of 63.3 ± 14.3 years, comorbidities including COPD (28.4%) and diabetes mellitus (42.1%), and was predominantly Caucasian (64.9%). The proportion of those admitted to the ICU was 54.7%, with 10.5% requiring tracheostomy and overall mortality 16.8%. Median duration between CT scans was 32 days (IQR: 16–63 days). Significant reductions in median per cent loss was noted for PM (−2.64% loss [IQR: −0.28, −5.47] in COVID‐19 vs. −0.06 loss [IQR: −0.01, −0.28] in non‐COVID‐19 CT controls, P < 0.001) and ESM (−1.86% loss [IQR: −0.28, −5.47] in COVID‐19 vs. −0.06 loss [IQR: −0.02, −0.11]) in non‐COVID‐19 CT controls, P < 0.001). Multivariate linear regression analysis of per cent loss in PM was significantly associated with mortality (−10.8% loss [95% CI: −21.5 to −0.19]) and ICU admission (−11.1% loss [95% CI: −19.4 to −2.67]), and not significant for ESM. Cox proportional hazard ratios demonstrated greater association with ICU admission (adj HR 2.01 [95% CI: 1.14–3.55]) and mortality (adj HR 5.30 [95% CI: 1.19–23.6]) for those with significant per cent loss in PM, and greater association with ICU admission (adj HR 8.22 [95% CI: 1.11–61.04]) but not mortality (adj HR 2.20 [95% CI: 0.70–6.97]) for those with significant per cent loss in ESM.ConclusionsIn a well‐characterized cohort of 95 hospitalized patients with acute COVID‐19 and two temporally distinct CT scans, acute sarcopenia, determined by standardized reductions in PM and ESM, was associated with worse clinical outcomes. These data lay the foundation for evaluating dynamic muscle loss as a predictor of clinical outcomes and targeting acute sarcopenia to improve clinical outcomes for COVID‐19.

What Do We Need to Know About Musculoskeletal Manifestations of COVID-19?: A Systematic Review.

COVID-19 is a disease that is challenging science, health-care systems, and humanity. An astonishingly wide spectrum of manifestations of multi-organ damage, including musculoskeletal, can be associated with SARS-CoV-2. In the acute phase of COVID-19, fatigue, myalgia, and arthralgia are the most common musculoskeletal symptoms. Post-COVID-19 syndrome is a group of signs and symptoms that are present for >12 weeks. The associated musculoskeletal manifestations are fatigue, arthralgia, myalgia, new-onset back pain, muscle weakness, and poor physical performance. Data on COVID-19 complications are growing due to large absolute numbers of cases and survivors in these 2 years of the pandemic. Additional musculoskeletal manifestations encountered are falls by the elderly, increased mortality after hip fracture, reduced bone mineral density and osteoporosis, acute sarcopenia, rhabdomyolysis, Guillain-Barré syndrome, muscle denervation atrophy, fibromyalgia, rheumatological disease triggering, septic arthritis, adhesive capsulitis, myositis, critical illness myopathy, onset of latent muscular dystrophy, osteonecrosis, soft-tissue abscess, urticarial vasculitis with musculoskeletal manifestations, and necrotizing autoimmune myositis. A wide range of signs and symptoms involving the musculoskeletal system that affect quality of life and can result in a decrease in disability-adjusted life years. This powerful and unpredictable disease highlights the importance of multimodality imaging, continuing education, and multidisciplinary team care to support preventive measures, diagnosis, and treatment.