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. 2022 Aug 3;17(1):110.
doi: 10.1007/s11657-022-01132-7.

Trends in osteoporosis care patterns during the COVID-19 pandemic in Alberta, Canada

T Oliveira  1 , J Brown  2 , A G Juby  3 , P Schneider  4 , R J Wani  1 , M Packalen  1 , S Avcil  1 , S Li  5 , M Farris  5 , E Graves  5 , S McMullen  6 , D L Kendler  7
Affiliations

Trends in osteoporosis care patterns during the COVID-19 pandemic in Alberta, Canada

T Oliveira et al. Arch Osteoporos. .

Abstract

Purpose/introduction: The objective of this study was to describe osteoporosis-related care patterns during the coronavirus disease 2019 (COVID-19) pandemic in Alberta, Canada, relative to the 3-year preceding.

Methods: A repeated cross-sectional study design encompassing 3-month periods of continuous administrative health data between March 15, 2017, and September 14, 2020, described osteoporosis-related healthcare resource utilization (HCRU) and treatment patterns. Outcomes included patients with osteoporosis-related healthcare encounters, physician visits, diagnostic and laboratory test volumes, and treatment initiations and disruptions. The percent change between outcomes was calculated, averaged across the control periods (2017-2019), relative to the COVID-19 periods (2020).

Results: Relative to the average control March to June period, all HCRU declined during the corresponding COVID-19 period. There was a reduction of 14% in patients with osteoporosis healthcare encounters, 13% in general practitioner visits, 9% in specialist practitioner visits, 47% in bone mineral density tests, and 13% in vitamin D tests. Treatment initiations declined 43%, 26%, and 35% for oral bisphosphonates, intravenous bisphosphonates, and denosumab, respectively. Slight increases were observed in the proportion of patients with treatment disruptions. In the subsequent June to September period, HCRU either returned to or surpassed pre-pandemic levels, when including telehealth visits accounting for 33-45% of healthcare encounters during the COVID periods. Oral bisphosphonate treatment initiations remained lower than pre-pandemic levels.

Conclusions: This study demonstrates the COVID-19 pandemic and corresponding public health lockdowns further heightened the "crisis" around the known gap in osteoporosis care and altered the provision of care (e.g., use of telehealth and initiation of treatment). Osteoporosis has a known substantial care and management disparity, which has been classified as a crisis. The COVID-19 pandemic created additional burden on osteoporosis patient care with healthcare encounters, physician visits, diagnostic and laboratory tests, and treatment initiations all declining during the initial pandemic period, relative to previous years.

Keywords: COVID-19; Care patterns; Healthcare resource utilization; Osteoporosis; Pandemic.

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Conflict of interest statement

SM, EG, MSF, and SL are employed by Medlior, which received funding for the study from Amgen Canada. TO, RW, MP, and SA are employed by Amgen Canada who funded this study and hold Amgen stock. DLK reports research support from Amgen, Astellas, AstraZeneca, and Eli Lilly, consulting fees from Amgen, Eli Lilly, Merck, and Pfizer, and is on the speakers’ bureau for Amgen, Eli Lilly, and GSK. JPB reports research support from Mereo BioPharma, Radius Health and Servier, consulting fees from Amgen, Paladin Labs Inc., Pfizer, and Servier, and is on the speakers’ bureau for Amgen. AGJ has participated in Advisory Boards for Amgen Canada and Paladin Labs Inc, and is on the speaker bureau for Amgen. PS reports research support from Johnson & Johnson, Smith & Nephew, and DePuy Synthes and has participated on Advisory Boards for Amgen.

Figures

Fig. 1
Fig. 1
The number of patients with osteoporosis-related healthcare encounters in Alberta, Canada, by 3-month control and COVID-19 periods. Abbreviations: COVID-19, coronavirus disease 2019; Dec, December; Jun, June; Mar, March; Sep, September. Note: The urban zone was defined as Calgary or Edmonton Alberta Health Services geographic health zones, while the rural zone was defined as Central, North and South Alberta Health Services geographic health zones. Note: Osteoporosis-related healthcare encounters include visits/admissions to the hospital, ambulatory care (including emergency department and outpatient), and practitioner claims as represented by an osteoporosis diagnostic code for the visit reason
Fig. 2
Fig. 2
The number of osteoporosis-related general and specialist practitioner visits in Alberta, Canada, by 3-month control and COVID-19 periods. Abbreviations: COVID-19, coronavirus disease 2019; Dec, December; Jun, June; Mar, March; Sep, September
Fig. 3
Fig. 3
The number of vitamin D laboratory tests and BMD tests in Alberta, Canada, by 3-month control and COVID-19 periods. Abbreviations: COVID-19, coronavirus disease 2019; Dec, December; Jun, June; Mar, March; Sep, September
Fig. 4
Fig. 4
Patients on and initiating* new osteoporosis-related treatments in Alberta, Canada, by 3-month control and COVID-19 periods. Abbreviations: COVID-19, coronavirus disease 2019; Dec, December; IV, intravenous; Jun, June; Mar, March; Sep, September. *Patients initiating an osteoporosis treatment without having received any osteoporosis treatment in the previous 1.5 years. Note: the size of the dots is indicative of the number of patients
Fig. 5
Fig. 5
Disruptions of greater than 60 days in osteoporosis-related treatments in Alberta, Canada, by 3-month control and COVID-19 periods. Abbreviations: COVID-19, coronavirus disease 2019; Dec, December; IV, intravenous; Jun, June; Mar, March; Sep, September. Total percent change in disruption rates is presented year over year. Note: treatment disruptions from the June to September 2020 period are not available at this time due to insufficient follow-up to identify treatment gaps of days’ supply + 60 days
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