Global impact of COVID-19 on non-communicable disease management:​ descriptive analysis of access to FRAX fracture risk online tool for prevention of osteoporotic fractures

McCloskey, E. V.; Harvey, N. C.; Johansson, H.; Lorentzon, M.; Vandenput, L.; Liu, E.; Kanis, J. A.

Affiliations

¹Department of Oncology and Metabolism, Academic Unit of Bone Metabolism, Metabolic Bone Centre, Northern General Hospital, Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield S5 7AU, UK

²Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK

³MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

⁴NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

⁵Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia

⁶Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

⁷Region Västra Götaland, Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Gothenburg, Sweden

Abstract and keywords

Summary: The COVID-19 pandemic, and its management, is markedly impacting the management of osteoporosis as judged by access to online FRAX fracture risk assessments. Globally, access was 58% lower in April than in February 2020. Strategies to improve osteoporosis care, with greater use of fracture risk assessments, offer a partial solution.

Introduction: The COVID-19 pandemic is having a significant detrimental impact on the management of chronic diseases including osteoporosis. We have quantified the global impact by examining changes in the usage of online FRAX fracture risk assessments before and after the declaration of the pandemic (11 March 2020).

Methods: The study comprised a retrospective analysis using GoogleAnalytics data on daily sessions on the FRAX® website (www.sheffield.ac.uk/FRAX) from November 2019 to April 2020 (main analysis period February–April 2020), and the geographical source of that activity.

Results: Over February–April 2020, the FRAX website recorded 460,495 sessions from 184 countries, with 210,656 sessions in February alone. In March and April, the number of sessions fell by 23.1% and 58.3% respectively, a pattern not observed over the same period in 2019. There were smaller reductions in Asia than elsewhere, partly related to earlier and less-marked nadirs in some countries (China, Taiwan, Hong Kong, South Korea and Vietnam). In Europe, the majority of countries (24/31, 77.4%) reduced usage by at least 50% in April. Seven countries showed smaller reductions (range − 2.85 to − 44.1%) including Poland, Slovakia, Czech Republic, Germany, Norway, Sweden and Finland. There was no significant relationship between the reduction in FRAX usage and measures of disease burden such as COVID-attributed deaths per million of the population.

Conclusion: This study documents a marked global impact of the COVID-19 pandemic on the management of osteoporosis as reflected by FRAX online fracture risk assessments. The analysis suggests that impact may relate to the societal and healthcare measures taken to ameliorate the pandemic.

Keywords: COVID-19; Fracture; FRAX; Non-communicable diseases (NCD); Osteoporosis

Links

DOI: 10.1007/s00198-020-05542-6

PubMed: 33057738

WoS: 000577228800002

History

Received: 2020-06-10

Accepted: 2020-07-07

Online: 2020-10-14

Cited Works (7)

Year	Entry
2017	Compston J, Cooper A, Cooper C, Gittoes N, Gregson C, Harvey N, Hope S, Kanis JA, McCloskey EV, Poole KES, Reid DM, Selby P, Thompson F, Thurston A, Vine N; The National Osteoporosis Guideline Group (NOGG). UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. December 2017;12(1):1-24.
2016	Kanis JA, Harvey NC, Cooper C, Johansson H, Odén A, McCloskey EV; The Advisory Board of the National Osteoporosis Guideline Group. A systematic review of intervention thresholds based on FRAX: a report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Arch Osteoporos. December 2016;11(1):25.
2019	Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. January 26, 2019;393(10169):364-376.
2013	Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA. Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos. December 2013;8(1):136.
2018	Cummings SR, Ferrari S, Eastell R, Gilchrist N, Jensen J-EB, McClung M, Roux C, Törring O, Valter I, Wang AT, Brown JP. Vertebral fractures after discontinuation of denosumab: a post hoc analysis of the randomized placebo-controlled FREEDOM trial and its extension. J Bone Miner Res. February 2018;33(2):190-198.
2020	Girgis CM, Clifton-Bligh RJ. Osteoporosis in the age of COVID-19. Osteoporos Int. July 2020;31(7):1189-1191.
2013	Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA; EU review panel of the IOF. Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos. December 2013;8(1):137.

Cited By (1)

Year	Entry
2022	Kocijan R, Stockinger T, Haschka J, Reichardt B, Resch H, Zwerina J, Behanova M. Dispensing anti-osteoporotic drugs changed during the COVID-19 pandemic. Bone. September 2022;162:116477.