Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria; Sigmund Freud University Vienna, School of Medicine, Metabolic Bone Diseases Unit, Vienna, Austria.
Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria.
Bone. 2022 Sep;162:116477. doi: 10.1016/j.bone.2022.116477. Epub 2022 Jun 29.
Caring for osteoporosis patients has proven challenging during the COVID-19 pandemic due to repeated lockdowns in Austria. The distinct possibility of insufficient treatment regimens is therefore a matter of pressing concern. The aim of the study was to assess alterations in dispensing anti-osteoporotic drugs during the COVID-19 pandemic.
PATIENTS/METHODS: This study was a nationwide retrospective register-based observational study which included all patients in Austria aged ≥50 who received at least one prescription for anti-osteoporotic medication between January 2016 and November 2020. Pseudonymised individual-level patients' data were obtained from social insurance authorities. Anti-osteoporotic agents were divided into: (i) oral bisphosphonates, (ii) intravenous bisphosphonates, (iii) selective estrogen receptor modulators (SERMs), (iv) teriparatide (TPTD) and (v) denosumab (DMAB). We used interrupted time series analysis with autoregressive integrated moving average models (ARIMA) to predict drug dispensing.
There were 2,884,374 dispensations of anti-osteoporotic drugs to 224,598 patients between 2016 and 2020. The mean monthly prescriptions for oral bisphosphonates (-14.5 %) and SERMs (-12.9 %) decreased during the COVID-19 pandemic when compared to the non-COVID-19 period. Dispensing for intravenous bisphosphonates (1.7 %) and teriparatide (9.5 %) increased. Prescriptions for DMAB decreased during the first lock-down, however increased by 29.1 % for the total observation time. The Arima models showed that in March 2020 (beginning of the 1st COVID-19 lockdown), there was a decrease of 778 dispensings, with a further increase of 14 dispensings every month for denosumab; a decrease by 178 dispensings, with a further increase of 23 dispensings every month for zolendronic acid; a decrease by 2950 dispensings, but with a further increase of 236 dispensings every other month for ibandronate and a decrease by 1443 dispensing with a further decrease of 29 dispensings for alendronate than predicted, had the lockdown not occurred.
The total number of prescriptions dispensed to patients treated with anti-osteoporotic medications declined rapidly during first COVID-19 lockdown. The observed decrease of DMAB during the first lockdown rebounded in the following months. Considering the massive treatment gap for osteoporosis, and the related fracture risk, clinicians should continue treatment, even during a pandemic.
由于奥地利反复封锁，在 COVID-19 大流行期间，照顾骨质疏松症患者极具挑战性。因此，治疗方案明显不足是一个紧迫的问题。本研究旨在评估 COVID-19 大流行期间抗骨质疏松药物配药的变化。
患者/方法：这是一项全国性的回顾性基于登记的观察性研究，纳入了 2016 年 1 月至 2020 年 11 月期间在奥地利年龄≥50 岁且至少接受过一次抗骨质疏松药物处方的所有患者。从社会保险机构获得了匿名化的个体患者数据。抗骨质疏松药物分为：（i）口服双膦酸盐，（ii）静脉用双膦酸盐，（iii）选择性雌激素受体调节剂（SERMs），（iv）特立帕肽（TPTD）和（v）地舒单抗（DMAB）。我们使用自回归综合移动平均模型（ARIMA）进行了中断时间序列分析，以预测药物配药情况。
2016 年至 2020 年期间，共为 224598 名患者开出了 2884374 份抗骨质疏松药物处方。与非 COVID-19 时期相比，COVID-19 大流行期间口服双膦酸盐（-14.5%）和 SERMs（-12.9%）的每月处方量减少。静脉用双膦酸盐（1.7%）和特立帕肽（9.5%）的处方量增加。DMAB 的处方在第一次封锁期间减少，但在整个观察期间增加了 29.1%。ARIMA 模型显示，2020 年 3 月（第一次 COVID-19 封锁开始时），配药量减少了 778 次，地舒单抗每月增加 14 次；唑来膦酸每月减少 178 次，每月增加 23 次；伊班膦酸盐每月减少 2950 次，每隔一个月增加 236 次；阿仑膦酸钠每月减少 1443 次，每月减少 29 次，与未发生封锁相比。
接受抗骨质疏松药物治疗的患者的总处方数量在第一次 COVID-19 封锁期间迅速下降。在第一次封锁期间观察到的 DMAB 减少在随后的几个月中反弹。考虑到骨质疏松症的大量治疗差距，以及相关的骨折风险，临床医生应继续治疗，即使在大流行期间也是如此。
