Osteoporosis providers report DXA scan delays, medication supply issues during COVID-19
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Adults with osteoporosis have had fewer in-person appointments, delayed DXA scans and interruptions with medication supplies during the COVID-19 pandemic, according to results from a global survey of physicians.
“The COVID-19 pandemic has direct effects, due to the virus itself, but also substantial, detrimental, indirect effects on the management of chronic diseases, including osteoporosis,” Nicholas Fuggle, MBBS, BSc, a fellow at the Alan Turing Institute and Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, U.K., and Cyrus Cooper, OBE, DL, FMedSci, professor of rheumatology and director of the MRC Lifecourse Epidemiology Unit, University of Southampton, U.K., told Healio. “Delays in treatment will lead to increases in fragility fracture risk and, potentially, a significant increase in the incidence of fragility fractures.”
Fuggle, Cooper and colleagues released two surveys to osteoporosis providers regarding alterations in treatment during the COVID-19 pandemic. One survey was sent to 400 providers in the National Osteoporosis Foundation’s Professional Partner Network and conducted from April 15 to 24. Another survey was sent to 526 providers in the International Osteoporosis Foundation’s Committee of Scientific Advisors and the Committee of National Societies and conducted from May 18 to June 8. Both surveys were conducted via the SurveyMonkey platform. Data from the two surveys were collected and merged for analysis. The findings were published in Osteoporosis International.
A total of 209 providers from 53 countries responded to the survey, with 28% coming from Europe, 24% based in North America, 19% from the Asia-Pacific region, 17% from the Middle East and 12% from Latin America. Among respondents, 40% represented rheumatology, 22% specialized in endocrinology, and 15% represented orthopedics. Of the respondents, 85% were physicians. At the time of the survey, 33% of respondents were performing telephone appointments, 21% did video consultations, 26% face-to-face appointments and 18% urgent in-person visits. Reimbursement for telemedicine was possible according to 48% of respondents, but 20% of respondents said reimbursement was not available.
Providers had varied answers when asked how DXA scanning was incorporated into osteoporosis risk assessment. One-third of respondents scheduled DXA for when the risk for COVID-19 infection was likely to have lessened, whereas 29% scheduled DXA scanning as soon as possible. Another 29% of respondents assessed patients with a clinical risk calculator while planning a DXA scan for a later date, whereas 11% assessed patients with a clinical risk calculator alone.
Of the respondents, 43% said they had difficulty arranging for appropriate osteoporosis medications during the pandemic. Reasons for the issues included a limited supply or difficulty acquiring medication, delays in administration of parenteral agents, reluctance of patients to attend medication administration appointments, and travel restrictions or self-isolation preventing patients from attending appointments. Sixty percent of providers said they had systems in place to identify those receiving subcutaneous or IV medication so that plans for care could be discussed with them.
Nearly all providers (93%) said electronic health record charting or input took the same amount or more time during the pandemic compared with before. Those who reported longer charting times cited communication and documentation, technical, treatment, safety and work-flow related issues. When asked about the time it took to follow-up with patients, 45% reported no change, whereas 39% said follow-up times were greater during the pandemic compared with before. Just 9% said follow-up times were shorter during the pandemic.
“These findings serve to highlight the detrimental effects the COVID-19 pandemic is having on osteoporosis assessment and management,” the researchers wrote. “At worst, this will result in a rise in fracture rates and a huge increase in individual morbidity and societal burden.”
For more information:
Cyrus Cooper, OBE, DL, FMedSci, can be reached at cc@mrc.soton.ac.uk.
Nicholas Fuggle, MBBS, BSc, can be reached at nrf@mrc.soton.ac.uk.
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