The coronavirus pandemic has made it necessary for doctors’ offices around the country to postpone elective procedures and conduct patient visits remotely via telemedicine, whenever possible. In the world of osteoporosis treatment, this presents a problem, as in-person visits are required for certain injection therapies that must be administered by a trained healthcare professional.
It can be tempting to overlook the risks of missing osteoporosis treatment during a world health crisis like the COVID-19 pandemic. Due to its lack of symptoms, osteoporosis has been called the silent killer or the silent epidemic, but the disease can often lead to early death, or force older people to give up their independence and move into an assisted living facility.
In the United States, 10.2 million women and men age 50 and older have osteoporosis, and 43.4 million Americans over 50 have low bone mass and are at a higher risk of fracture, according to data published in November 2014 in the Journal of Bone and Mineral Research. The overall risk of dying within one year of a hip fracture is about 1 in 5 for people age 60 or older, according to research published in the Geriatric Orthopaedic Surgery & Rehabilitation journal.
Experts are concerned about the short- and long-term impact of people stopping their osteoporosis therapy, and for good reason. Some hospitals are experiencing as much as an 80 percent decrease in osteoporosis treatment visits, according to a release issued by the American Society for Bone and Mineral Research.
The drop in the number of osteoporosis treatment visits is very concerning, according to Susan Williams, MD, an endocrinologist at the Cleveland Clinic in Ohio. “Just like any chronic condition, it is vitally important to continue treatment in order to have the best possible outcome; in the case of osteoporosis, that means preventing fractures in the future,” says Dr. Williams.
“Whether it is continuing to take an oral medication, calcium supplements, vitamin D, or an injectable medication, it is critical to not stop the treatment until you have talked with your doctor,” she says. Depending on the medication you’ve been prescribed, if treatment is abruptly stopped, fracture risk can rise dramatically, she adds.
In response to the disruption of care that the coronavirus has caused, the American Society for Bone and Mineral Research, American Association of Clinical Endocrinologists, Endocrine Society, European Calcified Tissue Society, and National Osteoporosis Foundation have released guidelines to help healthcare professionals who are treating people with osteoporosis during the social distancing challenges of the COVID-19 era.
The joint recommendations include the following:
Although these guidelines are helpful, it’s still important that each person talk to their doctor about their therapy, says Williams. “The risks of stopping treatment are dependent upon the drug that has been prescribed. If an oral medication is stopped temporarily, say, for a month or possibly two, there should be little long-lasting harm,” says Williams.
But, she continues, if a daily injectable is stopped for some reason, the benefits of the drug start to diminish rapidly, and the same can be said for romosozumab (Evenity). If denosumab (Prolia) is abruptly stopped and “another medication is not prescribed, the benefits of the therapy are rapidly lost and the risk of spine fracture starts to increase rather dramatically,” she says.
Williams recommends a telehealth visit if you were due for a follow-up visit with your physician concerning your bone health. “Don’t miss an opportunity to optimize your own skeletal health. Telemedicine visits can be conducted by telephone — no cell phone required — as well as via video-conferencing platforms, so please don’t let the concern of using unfamiliar technology prevent you from reaching out to your physician,” she says.
At the Cleveland Clinic, where Williams practices, providers use virtual visits to provide guidance on continuing a calcium-rich diet or calcium or vitamin D supplements, getting routine exercise, and keeping track of their last treatment.
“At our clinic, we have strongly encouraged patients to start coming in, since the restriction on in-person visits has been lifted, and we are prioritizing those patients who had to cancel their appointments for their last injection,” says Williams. Restrictions on these visits may vary from state to state.
If you’ve been on an injection for osteoporosis treatment and are switched to an oral therapy, there are a few things to keep in mind, says Williams.
Once in-person visits are possible and a person who was switched to an oral osteoporosis therapy is switched back to an injection, will there be any increased risks or impact on efficacy? The long-term impact is unknown, as we are in unchartered territory due to the pandemic, according to Williams. “But we know that the oral drugs help to preserve bone mass and bone strength, and it is safe to resume the injectable drugs,” she says.
“The pandemic has been unsettling to all of us, and our routines have been thrown off. With the stressors of these changes, it is easy to get out of the habit of taking medications as prescribed,” says Williams. If you are prescribed an oral medication, make sure you take it faithfully. Mark it on your calendar or set up reminders on your cell phone if need be, she says.
“If your appointment to receive an injectable osteoporosis medication has been delayed, stay in touch with your physician’s office and get rescheduled just as soon as they are able to see patients again,” she says.
It’s important to note that there is no evidence that osteoporosis drugs increase the risk or severity of COVID-19 infections, says Williams. “Unless a fracture occurs, osteoporosis is painless, so it can be easy to forget just how important it is to keep up with medications, supplements, and a healthy lifestyle. Be sure to take the time to take care of yourself,” she says.