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

Abstract

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.

Osteoporosis care during the COVID-19 pandemic in the Netherlands: A national survey

“…The COVID-19 pandemic has initiated changes in our management of chronic, not acute care, which includes osteoporosis. Not only in the Netherlands but also globally, this is observed; the online FRAX tool has been accessed 58% less when compared to the previous year [14]. During the acute phase of the pandemic, we have postponed non-urgent elective consultations, tests and even therapeutic interventions.…”

Diagnosis and Management of Osteoporosis During COVID-19: Systematic Review and Practical Guidance

“…It has been adopted in several country-specific guidelines for initiation of treatment to reduce fractures [ 13 – 15 ]. Although FRAX can be calculated on the basis of clinical risk factors alone and does not necessarily require attendance at hospital for a BMD measurement, a study by McCloskey and colleagues showed that the use of FRAX was significantly reduced over the 3-month period from February 2020 to April 2020 [ 16 ]. The number of sessions, defined as FRAX tool usage within a 30-min time frame, fell by 23% and 58% in March and April 2020 respectively compared to the same period in 2019.…”

“…In Latin America, the reductions were higher than 50% with smaller reductions seen in Asian countries. The authors estimated that over the 3-month period, approximately 500,000 fewer individuals were assessed for their risk of fracture than normal [ 16 ]. The reasons for this were not explored in the study but our experience suggests that this may have been due to difficulties in patients attending their GP’s and/or being referred to hospital clinics for these calculations due to diversion to resources from elective care to urgent care as the result of the pandemic.…”

The Impact of COVID-19 on the Optimal Management of Osteoporosis

“…The usages of the fracture risk assessment tool (FRAX) website for the periods of 2020 decreased, averaging 58% and ranging up to 96%, compared to the year of 2019. [22] Also, several fracture liaison services have been disrupted, compromising secondary fracture prevention. [23,24] Many facilities are dedicated to the COVID-19 crisis, and elective radiology including dual energy X-ray absorptiometry may be severely limited.…”