Diagnosis and Management of Osteoporosis During COVID-19: Systematic Review and Practical Guidance

Abstract

It is acknowledged that the COVID-19 pandemic has caused profound disruption to the delivery of healthcare services globally. This has affected the management of many long-term conditions including osteoporosis as resources are diverted to cover urgent care. Osteoporosis is a public health concern worldwide and treatment is required for the prevention of further bone loss, deterioration of skeletal micro-architecture, and fragility fractures. This review provides information on how the COVID-19 pandemic has impacted the diagnosis and management of osteoporosis. We also provide clinical recommendations on the adaptation of care pathways based on experience from five referral centres to ensure that patients with osteoporosis are still treated and to reduce the risk of fractures both for the individual patient and on a societal basis. We address the use of the FRAX tool for risk stratification and initiation of osteoporosis treatment and discuss the potential adaptations to treatment pathways in view of limitations on the availability of DXA. We focus on the issues surrounding initiation and maintenance of treatment for patients on parenteral therapies such as zoledronate, denosumab, teriparatide, and romosozumab during the pandemic. The design of these innovative care pathways for the management of patients with osteoporosis may also provide a platform for future improvement to osteoporosis services when routine clinical care resumes.

Keywords: COVID-19; FRAX; Osteoporosis; Osteoporosis management.

Fig. 1

PRISMA flow diagram of the search for eligible studies COVID-19 and osteoporosis or fractures

Fig. 2

Algorithm summarising the guidance to the management of osteoporosis during the COVID-19 pandemic in patients on parenteral treatment. All patients should continue calcium and/or vitamin D supplements and be encouraged to maintain a healthy-balanced diet and lifestyle such as stopping smoking, avoiding excessive alcohol intake (> 3 units/day), keeping active and exercising regularly. Adapted from Yu, E. W. et al. Osteoporosis management in the era of COVID-19 [53] and Gittoes et al. Endocrinology in the time of COVID-19: management of calcium metabolic disorders and osteoporosis [56]