Measures introduced back in March to create the emergency capacity needed to manage the COVID-19 pandemic have had a devastating impact on the delivery of routine healthcare including the management of those with osteoporosis. Widespread closure of elective services was implemented at short notice with little opportunity to put contingency plans in place and leaving patients unsupported and fearful. In the UK, the nurse-led helpline operated by the Royal Osteoporosis Society reflected this with its busiest period ever, receiving calls voicing concerns about susceptibility to COVID-19 infection, postponement of appointments and access to treatment. Most concerning were calls from patients with recent fragility fractures waiting for assessment or treatment and from others unable to access timely treatment with denosumab.
As has been the case internationally, the response from the UK bone community was swift and collaborative with the rapid development of pragmatic guidance aiming to provide support and practical advice to patients (https://theros.org.uk/information-and-support/coronavirus-and-osteoporosis/) and healthcare professionals (https://theros.org.uk/healthcare-professionals/covid-19-hub/). We have learnt to be refreshingly adaptable with introduction of imaginative and innovative practice including “drive-through” phlebotomy and injection services and patients being enabled to self-administer injectable therapies. We have also learnt how much can be achieved remotely, whether that be a one-to-one telephone consultation with an elderly woman in the next street or a webinar with hundreds of colleagues across the continent.
As lockdowns ease and we emerge into a recovery phase of the pandemic, we must not lose sight of this innovative spirit. The coming months will be challenging as we face an intimidating backlog of delayed appointments. Furthermore, delays in treatment combined with deconditioning because of prolonged shielding will lead to an inevitable increase in falls and fractures over the months to come. Many of our more vulnerable patients will remain fearful and unwilling to attend hospital appointments and restoration of services will be cautious and delivered at reduced capacity due to constraints imposed by stringent infection control.
It will only be possible to meet these challenges by adapting to the changed environment. We have an exciting opportunity to reshape our services to deliver high quality streamlined care in the most effective way for our patients, removing obstacles and inequalities. This will likely involve increased use of digital consultations and automated technology to improve identification of people at high risk of fracture and those with previously unidentified vertebral fractures. We must review how and where care is delivered, integrating this into the community and care homes and empowering the primary care team by providing accessible specialist support, advice and guidance to provide care of the highest standard. We must listen to our patients and ensure they shape these changes with us to create a worthwhile legacy for those who have suffered and perished in the course of the pandemic.
Consultant in Metabolic Bone Medicine, Sheffield Teaching Hospitals,
and Chair of the Clinical Committee of the Royal Osteoporosis Society, UK