In a recent article published in PLOS One, researchers determined whether patients with newly diagnosed osteoporosis received delayed pharmacologic treatment due to the coronavirus disease 2019 (COVID-19) pandemic.
Study: Impact of COVID-19 pandemic on pharmacologic treatment of patients newly diagnosed with osteoporosis. Image Credit: fizkes/Shutterstock/com
Background
Nearly 10 million individuals (≥50 years old) in the United States (US) have osteoporosis, with an estimated annual economic burden of $17.9 billion, which makes it a huge financial burden on public healthcare services.
Osteoporosis is a systemic skeletal disorder characterized by diminishing bone mineral density (BMD) and bone architecture.
Despite advancements in osteoporosis diagnosis and management, a care gap exists as many osteoporosis patients remain untreated or undertreated, especially males.
Previous studies have demonstrated delayed screening and undertreatment of patients with osteoporosis, especially men, which is challenging for healthcare providers as the number of fragility fractures in vulnerable people continues to rise.
A single-center observational study in the US showed a drastically lower screening rate (5.4% vs. 94.5%) and increased prevalence of fractures and secondary osteoporosis, 50% vs. 31% and 66.67% vs. 20.83%, respectively, in males versus females.
The COVID-19 pandemic further hindered the care of patients with osteoporosis. Accordingly, a survey study by Fuggle et al. found considerable delays in dual-energy x-ray absorptiometry (DXA) scanning, a rise in telemedicine appointments, and limited availability of osteoporosis drugs during the pandemic.
About the study
In the present study, researchers evaluated patients ≥50 years old who underwent DXA scanning at a tertiary center between March 1, 2018, and January 31, 2022, to quantitatively measure treatment rate and time to treatment for newly diagnosed osteoporosis patients of comparable age, sex, and ethnicity across pre- vs. pandemic times.
Patients diagnosed with osteoporosis between March 1, 2018 and January 31, 2020, and March 1, 2020 and January 31, 2022, comprised the pre-pandemic and pandemic cohorts, respectively.
Five medical students in this research study reviewed all participant's medical records between March 10, 2022, and May 25, 2022. They used the World Health Organization (WHO) criteria of a BMD T-score of ≤-2.5 on a DXA scan to identify a new diagnosis of osteoporosis.
The team assessed the proportion of patients who received pharmacologic therapy at three and six months of osteoporosis diagnosis, i.e., the time of DXA scan and the mean time from diagnosis to treatment initiation.
Specifically, the researchers assessed whether doctors used bisphosphonate, denosumab, parathyroid hormone analogs, and estrogen agonist/antagonist drugs for osteoporosis treatment.
Results
A total of 1,189 patients were newly diagnosed with osteoporosis during the study period, with 576 and 613 patients in the pre-pandemic and pandemic cohorts, respectively.
The study cohorts did not vary in age (69.3 vs. 68.8 years), gender (87 vs. 86.1% female), or ethnicity, although the number of White patients in the pre-pandemic cohort was higher (74.3 vs. 68.4%).
Moreover, patients treated at three and six months were similar between the pre-and COVID-19 pandemic cohorts.
Consistent with a study from North Carolina, this study reported the effect of racial differences on osteoporosis treatment. Accordingly, physicians offered guidance and treatment to more white women than black women.
However, among other races, White vs. non-White and Hispanic vs. non-Hispanic, the osteoporosis treatment rates remained comparable. Overall, the osteoporosis treatment rates were low (<45%) among all patients included in this study, even when stratified based on gender.
A previous study estimated a sharp decline (>50%) in the use of oral bisphosphonates in the US from 2008 to 2012 due to rising concerns about its safety.
Yet, per current study results, bisphosphonates remain the most prescribed medication in the pre-pandemic and pandemic cohorts (89% vs. 82.1%).
Conclusions
According to the authors, this is one of the first retrospective studies to compare the impact of the COVID-19 pandemic on the initiation of pharmacologic treatment of patients newly diagnosed with osteoporosis in the US.
They found that the COVID-19 pandemic did not markedly affect osteoporosis treatment rates; accordingly, 40.5% of patients with newly diagnosed osteoporosis received pharmacological treatment within six months of diagnosis.
Future studies should identify patient-, care provider-, and healthcare system-specific factors contributing to the effectiveness of osteoporosis treatment rates in the US, especially for patients newly diagnosed with osteoporosis.
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