In these unprecedented times, the changes in the model of healthcare towards chronic disease may be here to stay. Individuals with chronic conditions, such as frail older and immune-compromised people, have been recommended to avoid outdoor activity and limit their exposure to large groups of people, including attending hospitals and other centers of healthcare delivery. And clinical services designed to prevent morbidity and improve functional independence in older people, such as Fracture Liaison Services, will be scaled back, possibly for months, and suspended in their current form. The use of telemedicine has exponentially been adopted by members of the medical community but cannot replace clinical decision-making around the in-person assessment and management of osteoporosis, as well as many other chronic conditions. With rapid consideration and funds being funneled to responses to the COVID-19 pandemic, Christian M. Girgis, MD, PhD, was concerned that attention would turn away from the care of chronic disease. “Osteoporosis is a chronic disease that requires continued attention, is under-diagnosed, and results in significant morbidity and mortality among vulnerable, older patients if not treated,” he says. For a paper published in Osteoporosis International, Dr. Girgis and Roderick Clifton-Bligh, PhD, sought to clarify practical aspects of how to continue to treat patients with osteoporosis through the COVID-19 pandemic and the foreseeable future, including key impacts of COVID-19 on osteoporosis services and strategies to address these:
- DEXA units have been closed or working on reduced capacity, notes Dr. Girgis. “Therefore, the use of fracture risk calculators that take into consideration patient demographic information and previous fracture history could be used,” he adds.
- Careful patient education is needed for patients receiving IV bisphosphonates, as flu-like reactions are common among treatment-naïve patients with these agents. Dr. Girgis suggests that clinicians inform patients that these reactions can be easily differentiated from COVID-19 symptoms, mainly in that the latter results in respiratory symptoms, in order to avoid needless concern.
- During the pandemic, patients on long-term denosumab treatment may need to weigh the importance of regular, 6-month treatment intervals with that of avoiding in-persons visits with their clinician. “It is vital to be taken on time. Telehealth consultations to facilitate self-administration of denosumab should be considered,” says Dr. Girgis.
- Decisions around treatment escalations and other therapy changes will likely be challenging during the pandemic, according to Dr. Girgis. He adds that such changes may require face-to-face clinical encounters, and with various uncertainties during this time, patients may prefer to continue with current therapies.
- Although patients with osteoporosis are advised to engage in regular weight-bearing exercise to improve strength, balance, and posture while reducing fall risk, advice to avoid large gatherings can make gym and other exercise facility attendance impractical. Thus, “home-based exercise programs should be considered as an important way to keep active and prevent bone density loss during the phases of lockdown/reopening,” says Dr. Girgis.
- With patients with osteoporosis likely to be at high risk from sequelae of contracting COVID-19, Drs. Girgis and Clifton-Bligh note the importance of reiterating safe social distancing and regular hand-washing with this patient population.
“Clinicians must remember osteoporosis and chronic disease even in the midst of a public health crisis,” says Dr. Girgis. “Osteoporosis kills. Hip fractures have a significant mortality and morbidity, but they can be prevented with timely diagnosis and treatment of this very common condition.”