Osteoporosis is often described as “a silent disease.” During COVID, this has never been more true. Bone health took a back seat. Health assessments, bone density testing and sometimes treatment itself were upended by the pandemic. This disruption in care may have serious, long-term consequences for patients.“The impact is going to be seen both immediately and down the line, as we see people not getting diagnosed, not getting treated,” says Dr. Vivien Brown, a family physician, assistant professor with the department of family and community medicine, University of Toronto. “And ultimately, we may see an increase in fracture risk and fracture rate. And now, six months into COVID when we’re referring patients for bone density tests, there is a backlog.”
Screening for osteoporosis is critical, according to Dr. Brown, especially for women over the age of 50. More than breast cancer, more than heart attacks or stroke, women are most likely to experience a fracture due to weakened bones. Medical intervention to prevent or treat osteoporosis, as well as the adoption of healthy lifestyle behaviours, may be needed. Failing to diagnose the disease can lead to serious outcomes.
“Until they’ve had a fracture, until they’ve had an event, people don’t really have osteoporosis on their radar as a concern,” explains Dr. Brown, who just updated her book, A Woman’s Guide to Healthy Aging (to be published in January 2021). When COVID hit, the focus for healthcare was on providing essential services only. Bone density testing was not considered essential.”
Long-term consequences of the care gap
These interruptions have caused a care gap, making incidents like hip fractures an even greater concern. The research is alarming – 28 per cent of women and more than 37 percent of men over the age of 80 die in the first year after a hip fracture. “It can be a life-altering event, if not a life-ending event,” she says. “We really need to still maintain our level of vigilance around osteoporosis. And I don’t think that’s happening day to day in the medical community.”
Furthermore, she points out that hip fractures can become family tragedies, according to Dr. Brown. “Some patients can’t return home to live independently. They may not be able to walk without assistance. They may not ever be able to drive again. It really alters their quality of life, which impacts the entire family…. The way I think about osteoporosis is that it is not just a bone disease. Osteoporosis is your independence on the line.”
As the impact of COVID has rippled across the country, continuity of care for osteoporosis patients has suffered. For those who were prescribed injectable medications, missed shots were an issue. “The consequences are really significant because the benefits of an injectable medication are completely reversible,” points out Dr. Brown. “That means when you get past that six-month window where you’re supposed to get your next injection, if you go more than a month or so, you start to reverse the benefits you’ve had because the drug is out of your system. That reversal actually increases your risk of fracture. It’s really important to stay on schedule with this medication. It means being creative – either seeing your doctor for the injections, getting it from a pharmacist, or learning how to self-inject. Just delaying an injection is not acceptable.”
During COVID, the focus on osteoporosis decreased. Good lifestyle habits also waned as people stayed home. Sedentary behaviour and poor dietary habits increased, while the ability to exercise in a gym and access to healthy food was negatively impacted. “A number of my older patients who live at home alone and don’t want to go to the grocery store are not eating healthy diets,” she says. “And if they’re not checking in with their doctor and not being reminded of what they need to do – something gets forgotten or left by the wayside.”
“The Way I Think About Osteoporosis Is That It Is Not Just A Bone Disease. Osteoporosis Is Your Independence On The Line.”
Issues with fracture follow-up
The pandemic has had a profound impact on our social support systems, too, especially when someone goes into the hospital with a fracture. Due to safety protocols, they cannot have their partners or someone else with them to be present to listen to a doctor’s instructions post-discharge. It’s concerning to Dr. Brown who fears that something will be overlooked. “If you’re in the hospital by yourself, it may be scary and you may be in pain,” she says. “You may not hear what the doctor is saying clearly. You get your cast or have the fracture treated, then get sent home. I don’t know that people are getting good follow up care.”
That lack of follow-up has a direct impact on continuity of care – a key component in successful osteoporosis management. “In some ways, osteoporosis is like hypertension. Patients often don’t feel it,” she notes. “Maybe they take their drugs for a couple of months, but then stop taking them if the meds are not easily accessible, if they don’t understand them, or not feeling the impact of the disease… It’s important to adhere to whatever has been prescribed.”
Now, it’s time to get back on track and to make bone health a priority again. How do we do that? Here are a few pointers from Dr. Brown:
6 ways to get back on track with your bone health during COVID
- Contact your doctor for a health review, which should include a discussion of osteoporosis prevention and ensuring you’re up-to-date with any medications to treat the disease.
- Let your doctor know whether you’ve had a recent fracture. A fracture may need to be investigated further to rule out osteoporosis as an underlying cause.
- Take an easy online test to determine your risk of a fracture. The FRAX fracture assessment tool can be done in just a few minutes and will look at key factors to calculate how likely you are to experience a fracture in the next 10 years.
- Have your risk for osteoporosis assessed by a healthcare provider. Factors that heighten your risk include: low body weight, family history of osteoporosis or broken bones from a minor injury, lifestyle behaviours (smoking, having three or more alcoholic drinks a day, and being sedentary), certain medical conditions (like rheumatoid arthritis), being a woman over the age of 50, and certain medications.
- Ask your doctor or pharmacist whether it’s time to schedule a bone density test. It is recommended that all women and men over age 65 have routine bone density tests. Men and women from the age of 50 to 64 with risk factors for fractures should also be tested.
- Resume good habits, like eating a diet with adequate vitamin D and calcium, exercising and sitting less.
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