Rome, 16 July 2020 - The elderly are the most affected not only by Covid-19 but also by numerous other related pathologies, such as osteoporosis. The statistics speak for themselves: already today, 80 percent of people treated for a fracture do not receive anti-osteoporosis therapythus increasing the risk of related pathologies and new fractures.
The stop in recent months of healthcare activities on chronic diseases, such as osteoporosis and rehabilitation, leads experts to predict a new surge in fractures.
Prof. says this in an article published in the prestigious scientific journal Nature Reviews Endocrinology. Nicola Napoli, doctor of the Endocrinology unit of the Campus Bio-Medico University Hospital who raises the alarm: “In Italy, just 20 percent of patients with fractures undergo anti-osteoporosis therapy, while the remaining 80 percent receive no treatment. It is as if a patient, after a heart attack, was discharged without being prescribed treatment based, for example, on statins or beta-blockers. We want to make doctors and patients aware of a silent emergency that risks exploding in all its drama after the Covid-19 epidemic".
The ongoing pandemic around the world and the care of patients with bone fragility are therefore closely connected. The available data indicate that the majority of hospitalized patients with Covid-19 are over 60 on average, they are fragile subjects e with at least one other disease in progress which, together with immobilisation and long-term treatments, increase the risk of bone fragility and fractures. According to the latest data available in Italy there are about 3,5 million women and 1 million men affected by osteoporosis. Over the next 20 years, with the progressive aging of the population, a 25 percent increase in the over 65s is expected, and the Italian Osteoporosis Society estimates a proportional increase in the incidence of osteoporosis in the population.
Unfortunately in the Covid-19 emergency, in many countries of the world, osteoporosis patients have been classified as "non-urgent" since this pathology does not affect vital parameters. But for this very reason, experts predict one in the coming months dramatic upsurge in fractures and related mortality. "In patients aged 65 and over, immobilization rapidly leads to loss of muscle mass and strength – continues the prof. Nicholas Naples - This, together with other Covid-19-related pathologies, such as chronic inflammation and frailty, contributes to an increased likelihood of falls and related fractures".
Worldwide, osteoporosis is a growing disease with major physical, psychological and economic consequences for patients and their caregivers. Every year, in the United States alone there are more than 2 million fractures, while in Italy there are over 50 hip fractures in the over 90s. If in this emergency musculoskeletal diseases have been classified among the least risky, and treatments therefore considered deferrable, in reality - just to give an example - hip fractures can have serious consequences for the affected patients. “During the lockdown, many orthopedic, rehabilitation or chronic patient wards were closed, both to make room for Covid patients and to guarantee anti-contagion measures. As a result, hip fracture patients, if admitted to the hospital, were quickly discharged after the operation – concludes the prof. Nicola Naples - and often without proper post-surgical rehabilitation, osteoporosis treatments, or further follow-up recommendations. It follows an increased risk of developing all the complications related to hip fractures, such as bed rest, bedsores, infections, cardiovascular diseases that drastically increase the risk of disability and death.
The risk of death for patients with a hip fracture is 15 to 30% within a year: the incidence of osteoporotic fractures on mortality is substantially comparable to that of stroke and breast cancer. Furthermore, two thirds of those who survive often find themselves in a condition of permanent disability and dependence on family members and caregivers, not to mention the direct and indirect costs borne by the community.
For this the prof. Nicholas Naples appeal"At this point in the pandemic, more attention needs to be paid to those suffering from osteoporosis. The management of these patients is already complex under normal circumstances. With the pandemic still ongoing and considering the current difficulties in visiting patients in hospital settings, an effort is needed to guarantee them adequate treatments: in fact, continuity of care is not only a prerequisite for the success of the treatment itself, but it is important to ensure patient survival over time".
Specific guidelines on bone density screening and treatment during the COVID-19 pandemic have been developed by the American Society for Bone and Mineral Research (ASBMR), American Association of Clinical Endocrinologists, Endocrine Society, European Calcified Tissue Society and the National Osteoporosis Foundation And recommend treatment with vitamin D as it can have beneficial effects on the skeleton and muscle function, gait and immune system of patients with Covid-19. They also remind you to increase communication with patients about the importance of osteoporosis treatments. “It is strongly recommended Nicholas concludes Naples - that people with fragility fractures are managed in a multidisciplinary clinical setting and that not only adequate surgical treatment is guaranteed but also appropriate care after discharge".
