The impact of lockdown during the COVID-19 pandemic on osteoporotic fragility fractures: an observational study

Abstract

Summary We investigated whether osteoporotic fractures declined during lockdown, among adults aged 50 years and older. We showed that fewer outpatients attended the Fracture Clinic, for non-hip fractures, during lockdown; in contrast, no change in admissions for hip fractures was observed. This could be due to fewer outdoors falls, during lockdown. Purpose Many countries implemented a lockdown to control the spread of the COVID-19 pandemic. We explored whether outpatient attendances to the Fracture Clinic for non-hip fragility fracture and inpatient admissions for hip fracture declined during lockdown, among adults aged 50 years and older, in a large secondary care hospital. Methods In our observational study, we analysed the records of 6681 outpatients attending the Fracture Clinic, for non-hip fragility fractures, and those of 1752 inpatients, admitted for hip fracture, during the time frames of interest. These were weeks 1st to 12th in 2020 (“prior to lockdown”), weeks 13th to 19th in 2020 (“lockdown”) and corresponding periods over 2015 to 2019. We tested for differences in mean numbers (standard deviation (SD)) of outpatients and inpatients, respectively, per week, during the time frames of interest, across the years. Results Prior to lockdown, in 2020, 63.1 (SD 12.6) outpatients per week attended the Fracture Clinic, similar to previous years (p value 0.338). During lockdown, 26.0 (SD 7.3) outpatients per week attended the Fracture Clinic, fewer than previous years (p value < 0.001); similar findings were observed in both sexes and age groups (all p values < 0.001). During lockdown, 16.1 (SD 5.6) inpatients per week were admitted for hip fracture, similar to previous years (p value 0.776). Conclusion During lockdown, fewer outpatients attended the Fracture Clinic, for non-hip fragility fractures, while no change in inpatient admissions for hip fracture was observed. This could reflect fewer non-hip fractures and may inform allocation of resources during pandemic.

The incidence of arm, forearm, and hip osteoporotic fractures during early stage of COVID-19 pandemic

“…Therefore, an observation period limited to 77 days may not reflect the full-year picture of fracture incidence changes and overall cost for healthcare system. In an observational study in UK during lockdown, similar results were noted in regard to non-hip fractures but the number of hip fractures did not change [ 25 ]. The attendance to Fracture Clinic during lockdown was compared with respective data for the same period as in current study, e.g., years 2015–2019.…”

Mortality escalates in patients of proximal femoral fractures with COVID-19: A systematic review and meta-analysis of 35 studies on 4255 patients

“…Five more papers were discovered on hand search. After screening duplicates and excluding unrelated articles based on the title, 65 papers8–72 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 5 with 35 having hip fracture data were finally considered for review after full-text assessment. ( Fig.…”

“…1 However, early limited evidence published so far suggests poor outcomes with high postoperative mortality in patients with a hip fracture and concomitant COVID-19 infection (available studies indicate a mortality rate greater than 30%). 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 We have undertaken a ...…”

The COVID-19 Pandemic as a threatening for bone health

“…On the other hand, it remains yet unclear whether the restriction by the lockdown may affect the incidence of osteoporotic fragility fractures, due to reducing the number of outdoor falls and subsequent fractures among older adults (1,(12)(13)(14). For the moment, the effect of restriction of outdoor activities is more pronounced on the decrease of non-hip fragility fractures (including the forearm, upper arm, ankle, foot and others), compared with hip fractures, as more frequently the non-hip fractures occur outdoors whereas usually, the hip fractures occur indoors and in older people (12)(13). A large observational study, during the lockdown, proved that fewer outpatients attended the Fracture Clinic, for non-hip fractures, whereas there was no change in admissions for hip fractures (2).…”