Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, Lambeth Palace Road, 5th Floor, North Wing, London, SE1 7EH, UK.
Department of Rheumatology, Metabolic Bone Clinic, Guy's Hospital, London, UK.
Calcif Tissue Int. 2021 Oct;109(4):351-362. doi: 10.1007/s00223-021-00858-9. Epub 2021 May 18.
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.
人们认识到,COVID-19 大流行已在全球范围内对医疗保健服务的提供造成了深刻的破坏。由于资源被转移到紧急护理上,许多长期疾病的管理受到影响,包括骨质疏松症。骨质疏松症是一个全球性的公共卫生问题,需要进行治疗以防止进一步的骨质流失、骨骼微观结构恶化和脆性骨折。本综述提供了有关 COVID-19 大流行如何影响骨质疏松症诊断和管理的信息。我们还根据五个转诊中心的经验提供了关于护理途径适应的临床建议,以确保骨质疏松症患者仍得到治疗,并降低个体患者和整个社会骨折的风险。我们讨论了 FRAX 工具在风险分层和骨质疏松症治疗开始中的应用,并鉴于 DXA 的可用性有限,讨论了治疗途径的潜在调整。我们关注在大流行期间开始和维持对使用唑来膦酸、地舒单抗、特立帕肽和罗莫佐单抗等肠外治疗的患者进行治疗的问题。这些管理骨质疏松症患者的创新护理途径的设计也可能为常规临床护理恢复后改善骨质疏松症服务提供一个平台。