COVID-19 Pandemisinin Osteoporoz Tanı ve Takibi Üzerine Etkileri

Abstract

Amaç: Koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) pandemisi, osteoporoz gibi birçok kronik hastalığın takip ve tedavi sürecini etkilemiştir. Bu çalışmanın amacı, osteoporoz tanısı alan hastaların 25-hidroksivitamin D (25(OH)D) düzeyleri ve kemik mineral yoğunluğu (KMY) ölçümlerinin COVID-19 pandemisi sırasında etkilenip etkilenmediğini belirleyerek takip ve tedavi protokollerindeki değişiklikleri saptamaktır. Gereç ve Yöntemler: Çalışmaya 1 Aralık 2018 ile 1 Mart 2020 tarihleri arasında osteoporoz tanısı almış 598 hasta dahil edildi. Pandemi sonrası takip süresi, femur boynu T-skoru ve KMY değeri, lomber vertebra toplam (L1-4) T-skoru ve KMY değeri, 25(OH)D düzeyleri ve osteoporoz için uygulanan medikal tedaviler geriye dönük olarak kaydedildi. Bulgular: Pandemi sonrası ortalama takip süresi 2 yıl olarak belirlendi. Pandemi sonrası dönemde 25(OH)D düzeyleri pandemi öncesine göre anlamlı olarak daha yüksekti (p<0,001). Lomber toplam T-skorları ve KMY değerleri, femur boynu T-skorları ve KMY değerleri pandemi öncesi dönemde daha yüksekti (hepsi için p<0,001). Osteoporoz tedavisinde pandemi sonrası dönemde denosumab kullanım sıklığında pandemi öncesi döneme göre istatistiksel olarak anlamlı bir artış saptandı (p<0,001). Sonuç: Pandemi öncesi döneme kıyasla hasta takibinde gecikme, KMY ve T-skorlarında azalma, 25(OH)D düzeylerinde artış ve yalnızca denosumab ile tedavide artış gözlenmiştir. Özellikle sağlık hizmetlerine erişimin zorlaştığı dönemlerde, osteoporoz tanı ve takibi için uzaktan değerlendirme yöntemlerinin geliştirilmesi ve hasta eğitimi yoluyla tedavilerin evde mümkün olduğunca erişilebilir hale getirilmesi büyük önem taşımaktadır.

Keywords

• COVID-19
• osteoporoz
• pandemi
• tedavi
• D vitamini

The Effects of the COVID-19 Pandemic on the Diagnosis and Follow-up of Osteoporosis

Abstract

Aim: The coronavirus disease 2019 (COVID-19) pandemic has impacted the follow-up and treatment processes of many chronic diseases, including osteoporosis. This study aimed to determine whether 25-hydroxyvitamin D (25(OH)D) levels and bone mineral density (BMD) measurements in patients diagnosed with osteoporosis were affected during the COVID-19 pandemic to assess changes in follow-up and treatment protocols. Material and Methods: The study included 598 patients diagnosed with osteoporosis between December 1, 2018, and March 1, 2020. The duration of follow-up after the pandemic, femoral neck T-score and BMD value, lumbar vertebrae total (L1-4) T-score and BMD value, 25(OH)D levels, and medical treatments for osteoporosis were recorded retrospectively. Results: The mean duration of follow-up visits after the pandemic was nearly two years. 25(OH)D levels were significantly higher in the post-pandemic period than in the pre-pandemic period (p<0.001). Lumbar total T-scores and BMD values, femoral neck T-scores, and BMD values were higher in the pre-pandemic period (p<0.001 for all). There was a statistically significant increase in the frequency of denosumab use in the post-pandemic period compared to the pre-pandemic period in the treatment of osteoporosis (p<0.001). Conclusion: There is a delay in follow-up of patients, a decrease in BMD and T-scores, an increase in 25(OH)D levels, and an increase in treatment only with denosumab compared to the pre-pandemic period. It is essential to develop remote assessment methods for diagnosing and monitoring osteoporosis, particularly when accessing health services is challenging, and to make treatments as accessible as possible at home through patient education.

Keywords

• COVID-19
• osteoporosis
• pandemic
• treatment
• Vitamin D

References

1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382(18):1708-20.
2. Rosenbaum L. The untold toll - the pandemic's effects on patients without Covid-19. N Engl J Med. 2020;382(24):2368-71.
3. Yu EW, Tsourdi E, Clarke BL, Bauer DC, Drake MT. Osteoporosis management in the era of COVID-19. J Bone Miner Res. 2020;35(6):1009-13.
4. Schousboe JT, Shepherd JA, Bilezikian JP, Baim S. Executive summary of the 2013 International Society for Clinical Densitometry Position Development Conference on bone densitometry. J Clin Densitom. 2013;16(4):455-66.
5. Holick MF. Optimal vitamin D status for the prevention and treatment of osteoporosis. Drugs Aging. 2007;24(12):1017-29.
6. Kirazlı Y, Atamaz Çalış F, El Ö, Gökçe Kutsal Y, Peker Ö, Sindel D, et al. Updated approach for the management of osteoporosis in Turkey: a consensus report. Arch Osteoporos. 2020 Aug 29;15(1):137.
7. Madeo B, Zirilli L, Caffagni G, Diazzi C, Sanguanini A, Pignatti E, et al. The osteoporotic male: overlooked and undermanaged? Clin Interv Aging. 2007;2(3):305-12.
8. Rochira V, Balestrieri A, Madeo B, Zirilli L, Granata AR, Carani C. Osteoporosis and male age-related hypogonadism: role of sex steroids on bone (patho)physiology. Eur J Endocrinol. 2006;154(2):175-85.

9. Peeters JJM, van den Berg P, van den Bergh JP, Emmelot-Vonk MH, de Klerk G, Lems WF, et al. Osteoporosis care during the COVID-19 pandemic in the Netherlands: A national survey. Arch Osteoporos. 2021;16(1):11.
10. Hampson G, Stone M, Lindsay JR, Crowley RK, Ralston SH. Diagnosis and management of osteoporosis during COVID-19: systematic review and practical guidance. Calcif Tissue Int. 2021;109(4):351-62.
11. Fuggle NR, Singer A, Gill C, Patel A, Medeiros A, Mlotek AS, et al. How has COVID-19 affected the treatment of osteoporosis? An IOF-NOF-ESCEO global survey. Osteoporos Int. 2021;32(4):611-7.
12. Obitsu S, Ahmed N, Nishitsuji H, Hasegawa A, Nakahama K, Morita I, et al. Potential enhancement of osteoclastogenesis by severe acute respiratory syndrome coronavirus 3a/X1 protein. Arch Virol. 2009;154(9):1457-64.
13. Awosanya OD, Dalloul CE, Blosser RJ, Dadwal UC, Carozza M, Boschen K, et al. Osteoclast-mediated bone loss observed in a COVID-19 mouse model. Bone. 2022;154:116227.
14. Mi B, Xiong Y, Zhang C, Zhou W, Chen L, Cao F, et al. SARS-CoV-2-induced overexpression of miR-4485 suppresses osteogenic differentiation and impairs fracture healing. Int J Biol Sci. 2021;17(5):1277-88.
15. Zhou W, Liu Y, Tian D, Wang C, Wang S, Cheng J, et al. Potential benefits of precise corticosteroids therapy for severe 2019-nCoV pneumonia. Signal Transduct Target Ther. 2020;5(1):18.
16. Buckley L, Humphrey MB. Glucocorticoid-induced osteoporosis. N Engl J Med. 2018;379(26):2547-56.
17. Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, et al. Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients. 2020;12(4):988.
18. Teshome A, Adane A, Girma B, Mekonnen ZA. The impact of vitamin D level on COVID-19 infection: systematic review and meta-analysis. Front Public Health. 2021;9:624559.
19. Jolliffe DA, Camargo CA Jr, Sluyter JD, Aglipay M, Aloia JF, Ganmaa D, et al. Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials. Lancet Diabetes Endocrinol. 2021;9(5):276-92.
20. McKenna MJ, Lyons OC, Flynn MA, Crowley RK, Twomey PJ, Kilbane MT. COVID-19 pandemic and vitamin D: rising trends in status and in daily amounts of vitamin D provided by supplements. BMJ Open. 2022;12(8):e059477.
21. Satış S, Yetişgin A. Did wearing mask and lockdowns affect vitamin D levels during the coronavirus disease-2019 pandemic? Turk J Osteoporos. 2021;27(2):109-13.
22. Atmaca A, Demirci I, Haymana C, Tasci I, Sahin I, Cakal E, et al. No association of anti-osteoporosis drugs with COVID-19-related outcomes in women: a nationwide cohort study. Osteoporos Int. 2022;33(1):273-82.
23. Özşahin M, Büyükkaya R, Kaya E, Baki AE, Aydin Y, Çelebi E, et al. The comparison of effectiveness of teriparatide and alendronate sodium in postmenopausal osteoporosis treatment. Duzce Med J. 2013;15(3):30-3.
24. Girgis CM, Clifton-Bligh RJ. Osteoporosis in the age of COVID-19. Osteoporos Int. 2020;31(7):1189-91.