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How has Covid-19 affected the treatment of osteoporosis?

IOF, NOF and ESCEO survey captures profound alterations in global osteoporosis care, assessment and treatment, including delays in DXA scanning, interrupted supply of medicines and delivery of medication, and increase in telemedicine consultations.

A global survey of healthcare providers by the International Osteoporosis Foundation (IOF), the National Osteoporosis Foundation (NOF) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) has revealed unprecedented effects of the Covid-19 pandemic on worldwide healthcare delivery for osteoporosis.

Osteoporosis is a chronic, age-related disease which is associated with life-changing fragility fractures. Approximately 740,000 people lose their lives following hip fractures every year.

The survey report is based on online questionnaires completed from April to June 2020 by 209 healthcare providers in 53 countries: 28% from Europe, 24% from North America, and 19%, 17% and 12% from the Asia-Pacific, Middle East and Latin America, respectively. The majority of the respondents (85%) were physicians, mainly representing the specialties of rheumatology (40%), endocrinology (22%), orthopaedics (15%) and internal medicine (11%).



The effects of COVID-19 have the potential to impact on the management of chronic diseases including osteoporosis. A global survey has demonstrated that these impacts include an increase in telemedicine consultations, delays in DXA scanning, interruptions in the supply of medications and reductions in parenteral medication delivery.


The COVID-19 pandemic has had profound effects on the health of the global population both directly, via the sequelae of the infection, and indirectly, including the relative neglect of chronic disease management. Together the International Osteoporosis Foundation and National Osteoporosis Foundation sought to ascertain the impact on osteoporosis management.


Questionnaires were electronically circulated to a sample of members of both learned bodies and included information regarding the location and specialty of respondents, current extent of face to face consultations, alterations in osteoporosis risk assessment, telemedicine experience, alterations to medication ascertainment and delivery and electronic health record (EHR) utilisation. Responses were collected, quantitative data analysed, and qualitative data assessed for recurring themes.


Responses were received from 209 healthcare workers from 53 countries, including 28% from Europe, 24% from North America, 19% from the Asia Pacific region, 17% from the Middle East and 12% from Latin America. Most respondents were physicians (85%) with physician assistants, physical therapists and nurses/nurse practitioners represented in the sample. The main three specialties represented included rheumatology (40%), endocrinology (22%) and orthopaedics (15%). In terms of the type of patient contact, 33% of respondents conducted telephone consultations and 21% video consultations. Bone mineral density assessment by dual-energy X-ray absorptiometry (DXA) usage was affected with only 29% able to obtain a scan as recommended. The majority of clinicians (60%) had systems in place to identify patients receiving parenteral medication, and 43% of clinicians reported difficulty in arranging appropriate osteoporosis medications during the COVID-19 crisis.


To conclude through surveying a global sample of osteoporosis healthcare professionals, we have observed an increase in telemedicine consultations, delays in DXA scanning, interrupted supply of medications and reductions in parenteral medication delivery.


Fuggle, N.R., Singer, A., Gill, C. et al. How has COVID-19 affected the treatment of osteoporosis? An IOF-NOF-ESCEO global survey. Osteoporos Int (2021). https://doi.org/10.1007/s00198-020-05793-3

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