COVID-19 Pandemic Slashed Global Rate of FRAX Assessments by More than 50%

Eugene McCloskey, MD

In a warning to clinicians, new research suggests rates of rate of Fracture Risk Assessment Tool (FRAX) fracture risk assessments were down more than 50% as a result of the coronavirus disease 2019 (COVID-19) pandemic.

Results of the analysis, which included data from more than 180 countries, found global access to the online risk assessment tool was 58% lower in April 2020 than February 2020—suggesting more than 500,000 patients could have been excluded during a 3-month period.

“The findings of this study reveal that, since the pandemic was officially declared by the WHO on March 11, there has been a dramatic drop in FRAX usage, averaging 58% but ranging up to 96%, with two-thirds of the 66 countries/territories evaluated showing reductions by at least 50%,” said lead investigator Eugene McCloskey, MD Professor in Adult Bone Disease at the Department of Oncology and Metabolism, at the University of Sheffield in the United Kingdom, in a statement from International Osteoporosis Foundation (IOF).

With the impact of the COVID-19 pandemic on usage of health care services noted across multiple fields, investigators sought to explore how the pandemic impacted management of osteoporosis on an international level. To do so, McCloskey and a team of colleagues from Europe and Australia designed a retrospective analysis to assess data on world-wide and country/territory specific usage of the online FRAX fracture risk assessments before and after the declaration of the pandemic on March 11, 2020.

As part of the study, investigators performed an analysis of global FRAX access, through use of GoogleAnalytics data, and determined usage rates from November 2019-April 2020. From this initial analysis, investigators determined usage were stable from November 2019-February 2020. Using this information, investigators chose February-April 2020 as the main analysis period for their study.

From February-April 2020, 460,495 sessions from 184 countries were recorded on the FRAX website. Of these, 45.74% (n=210,656) occurred during February. During March and April 2020, investigators noted declines in sessions of 23.1% and 58.3%, respectively, which they pointed out was not observed in the analysis of the same time period during 2019.

In North America, declines of 60.9% and 44.9% were reported in the US and Canada, respectively. All 8 Latin American countries included reported reductions of 50% or greater in April. Of these, this smallest reduction occurred in Brazil (-54.5%) and the greatest occurred in Ecuador (76.9%).

In European countries, 24 of 31 countries with data reported declines of at least 50% in April—with Poland (-2.85%), Slovakia (-21.2%), the Czech Republic (-22.6%), Germany (-26.9%), Norway (-31.7%), Sweden (-41.4%) and Finland (-44.1%) as the only countries reporting reductions of less than 50%.

Investigators pointed out smaller reductions were noted in Asia from February-April 2020. In the analysis, Asia was the only region with countries to report an increase in FRAX assessments during the study period—with Taiwan (4.0%), Hong Kong (23.5%), South Korea (35.3%), China (51.7%), and Vietnam (232.8%) all reporting increases in FRAX sessions.

However, in an analysis comparing rates to November 2019, China and Taiwan reported reductions in FRAX assessments of 33.3% or greater occurring in January 2020 while Hong Kong, Vietnam, and South Korea reported reductions of 30% or greater occurring in February 2020.

In the aforementioned statement, investigators caution against overinterpretation of results due to their study being limited by use of GoogleAnalytics as a metric for FRAX assessment usage and an inability to account for measurements conducted on bone densitometers.

“The drastic reduction in FRAX usage underscores widespread concern that the COVID-19 pandemic is having a detrimental impact on the medium to long-term management and outcomes for many NCDs, with serious repercussions for individuals who are not able to access timely testing and treatment, including for osteoporosis,” said Professor John Kanis, Honorary President of the IOF and Director of the Centre for Metabolic Bone Diseases at University of Sheffield.

This study, “Global impact of COVID-19 on non-communicable disease management: descriptive analysis of access to FRAX fracture risk online tool for prevention of osteoporotic fractures,” was published in Osteoporosis International.