Joint position statement on management of patient with osteoporosis during COVID-19 contingency from the AMMOM, CONAMEGER, FELAEN, FEMECOG, FEMECOT, and ICAAFYD

Abstract

Infection by SARS-Cov-2 (COVID-19) has affected practically all the world. This joint position statement of Latin American Medical Societies provides an updated guide for the prevention, diagnosis, and treatment of osteoporotic patients in the face of possible clinical scenarios posed by the COVID-19 health crisis. Background Infection by SARS-Cov-2 (COVID-19) has affected practically all the world. Characterized by high contagiousness, significative morbidity, and mortality in a segment of those infected, it has overwhelmed health services and forced to redirect resources to the emergency while impacting the attention of acute non-COVID-19 and many chronic conditions. Objective The objective of this study is to provide an updated guide for the prevention, diagnosis, and treatment of osteoporotic patients in the face of possible clinical scenarios posed by the COVID-19 health crisis. Methods A task force, of bone specialists with a wide range of disciplines in the field of osteoporosis and fragility fracture, was convened with the representation of several professional associations, namely, the Mexican Association of Bone and Mineral Metabolism (AMMOM), the National College of Geriatric Medicine (CONAMEGER), the Latin American Federation of Endocrinology (FELAEN), the Mexican Federation of Colleges of Obstetrics and Gynecology (FEMECOG), the Mexican Federation of Colleges of Orthopedics and Traumatology (FEMECOT), and the Institute of Applied Sciences for Physical Activity and Sports of the University of Guadalajara (ICAAFYD). Clinical evidence was collated, and an evidence report was rapidly generated and disseminated. After finding the gaps in the available evidence, a consensus opinion of experts was made. The resulting draft was reviewed and modified accordingly, in 4 rounds, by the participants.

Dispensing anti-osteoporotic drugs changed during the COVID-19 pandemic

“…The initiation and continuation of anti-osteoporotic treatment during the COVID-19 pandemic was repeatedly recommended by the National Osteoporosis Foundation. Osteoporosis patients should not delay initiation or continuation of treatment [27] . Oral bisphosphonates may be favourable in pandemic situations compared to parenteral agents [28] .…”

Fragility fracture systems, Latin America perspective

“…After stratifying the need of care, we could know which interventions should be done and which ones could be postponed for some time [13] . These guidelines stipulate that during fragility fracture treatment, detection, and management, rehabilitation and fall prevention interventions are essential parts of management that should not be overlooked.…”

“…During the coronavirus disease 2019 pandemic restrictions and due to the limited access of DXA scans in Mexico, the diagnosis of osteoporosis can be preliminarily made based on clinical and radiographic findings in some patients. Laboratory tests should be performed before starting osteoporosis medication [13] …”

What is Missing in the Diagnosis and Treatment of Osteoporosis Including the Impact of the SARS-CoV-2 Pandemic?

“…Meanwhile, the SARS-CoV-2 pandemic has very visibly highlighted the lack of access to basic diagnostics. Many patients already using injection treatment may have completely abandoned therapy, and in the case of oral drugs, not taken them regularly [68]. As a consequence, this will contribute to the recurrence of the disease, as well as a real increase in the risk of another fracture [69].…”