COVID-19 Pandemic Reduces Access to Osteoporosis Care

Nicholas Fuggle, MBBS, BSc

The coronavirus disease 2019 (COVID-19) has had an impact in virtually every medical space and condition, including osteoporosis.

A team, led by N.R. Fuggle, MRC Lifecourse Epidemiology Unit, University of Southampton, conducted a global survey to show how the ongoing pandemic has impacted this patient population, finding a number of changes to health care including an increase in telemedicine use, delays in dual energy X-ray absorptiometry (DXA) scanning, interruptions in the supply of medications and a reduction in parenteral medication delivery.

Osteoporosis Care

Since the spread of COVID-19 has transformed into a global pandemic, there has been disruptions to health care across the globe. This has had effects on the health of the global population both directly through the sequelae of the infection and indirectly, including the relative neglect of chronic disease management.

The pandemic has presented logistic challenges in health care, adding a hurdle to the ascertainment and delivery of good, including medications, as well as the necessary redeployment of staff to in-patient units has likely impacted out-patient services.

This can be particularly challenging for the assessment and management of osteoporosis, which is largely performed in an out-patient setting, with care combining the prescribing and delivery of anti-osteoporosis medications.

For example, access to the online FRAX fracture risk assessment system was approximately 60% lower in April 2020 than it was during February 2020.

An International Survey

Questionnaires were electronically circulated last spring to a sample of members of boththe International Osteoporosis Foundation and National Osteoporosis Foundation.

The questionnaires included information regarding the location and specialty of respondents, current extent of face to face consultations, alterations in osteoporosis risk assessment, telemedicine experience, alterations to medication ascertainment, and delivery and electronic health record (EHR) utilization.

The investigators collected the responses, analyzed the quantitative data and assessed the qualitative data for recurring themes.

Overall, 209 healthcare workers from 53 countries responded, including 28% from Europe, 24% from North America, 19% from the Asia Pacific region, 17% from the Middle East, and 12% from Latin America.

The majority of respondents were physicians (85%) with physician assistants, physical therapists, and nurse/nurse practitioners also represented in the sample.

The main 3 specialties represented included rheumatology (40%), endocrinology (22%), and orthopedics (15%).

In addition, 33% of respondents conducted telephone consultations, while 21% of respondents conducted video consultations.

Bone mineral density assessment using DXA scanning was impacted greatly, with only 29% of respondents able to obtain a scan as recommended.

The majority of clinicians (60%) had systems in place to identify patients receiving parenteral medication, while 43% of clinicians reported difficulty in arranging appropriate osteoporosis medications during the ongoing pandemic.

“To conclude through surveying a global sample of osteoporosis healthcare professionals, we have observed an increase in telemedicine consultations, delays in DXA scanning, interrupted supply of medications and reductions in parenteral medication delivery,” the authors wrote.

The study, “How has COVID-19 affected the treatment of osteoporosis? An IOF-NOF-ESCEO global survey,” was published online in Osteoporosis International.