State of Fragility Fractures Management during the COVID-19 Pandemic

Umberto Tarantino,Donato Casamassima,Elena Gasbarra,Virginia Tancredi,Eleonora Piccirilli,Riccardo Iundusi,Ida Cariati

doi:10.3390/ijerph17217732

Abstract

Osteoporosis is a public health concern all over the world. As a chronic condition, it generally requires prolonged medical interventions to limit the risks of further bone loss, impaired skeletal integrity and the onset of fractures. This problem is further complicated by the fact that the abrupt cessation of some therapies may be associated with an increased risk of harm. It is in this context that the COVID-19 pandemic has caused an unprecedented disruption to the provision of healthcare worldwide, exceeding our worst expectations in terms of the number of lives lost and the rapidity at which consolidated economies and healthcare systems are being significantly damaged. In this review, we assessed the challenges and strategies used in the management of osteoporosis and fragility fracture care during the COVID-19 pandemic. We also examined the available evidence and provided clinical recommendations that will require reassessment as the worldwide response to COVID-19 evolves.

Highlights

The COVID-19 pandemic has undoubtedly had, and will continue to have, a significant impact on the lives of people who live with and are at risk of osteoporosis
In patients affected by COVID-19, such a systemic condition could be associated with a lasting state of hypomobility, which would aggravate the condition of sarcopenia [4] and deplete the skeletal tissue of the mechanical stimuli necessary to maintain its natural trophism
It ensures a good level of bone mineralization; vitamin D deficiency produces serious clinical consequences at the bone level that result in a reduction in bone mass and an increased risk of osteoporotic fractures, in particular of the femur [30,31,32]

Summary

Introduction

The COVID-19 pandemic has undoubtedly had, and will continue to have, a significant impact on the lives of people who live with and are at risk of osteoporosis. Osteoporosis generally requires prolonged medical interventions to limit the risks of further bone loss, impaired skeletal integrity and the onset of fractures This problem is further complicated by the fact that the abrupt discontinuation of some therapies may be associated with an increased risk of harm [5]. Since to date there is no vaccine or specific drug therapy for COVID-19, the current treatment consists in isolating the patient and managing the clinical symptoms For this reason, many countries have adopted a series of restrictive measures to mitigate the spread of the virus. Many countries have adopted a series of restrictive measures to mitigate the spread of the virus These strategies of social distancing have been necessary from a public health perspective, they have understandably introduced challenges in the management of many chronic medical conditions [6], including osteoporosis. The aim of this review was to examine the impact of the COVID-19 pandemic on the management of fragility fractures, with particular reference to diagnosis strategies and changes in medical therapies for osteoporosis

Definition of Osteoporosis

Changes in Medical Therapies for Osteoporosis during the COVID-19 Pandemic

Recommendations at the Time of COVID-19

Findings

Conclusions