Secondary prevention of fragility fractures: where do we stand during the COVID-19 pandemic?

Abstract

Fragility fractures (FF) represent a public health issue affecting 30% of women and 20% of men aged > 50 years whose incidence is expected to increase by 2050 [1]. After a FF, patients are five times more likely to experience a second fracture within the next 2 years and starting effective treatment and preventive strategies in a timely fashion could be key to the prevention of these secondary fractures. FFs are associated with serious adverse events such as the refracture risk, impairing the quality of life, and mortality. Patients undergoing a fragility fracture are at imminent risk of a subsequent fractures, defined as the increased risk of fracture in the next 12–24 months [2]. This has to be considered especially in the light of the coronavirus disease 2019 (COVID-19) pandemic [3]. COVID-19 is still a main worldwide public health threat, causing globally 2.107.554 deaths by January 24th, 2021 (https:// covid 19. who. int/). Bone fragility should be taken into high consideration in COVID-19 patients. Inflammation, immobilization, hospitalization, and home isolation are all factors promoting bone and muscle loss, thereby increasing the risk of falls, fractures and death especially in the elderly [3, 4]. Consequently, patients with COVID-19 should be considered at imminent risk of fracture and early detection of FFs risk is of paramount importance. Although FF are considered important warning signs for subsequent fractures at any other skeletal sites, the secondary prevention of FFs is still mostly neglected. The prevention of FF may be considered even more important than treating the first FF that occurs. It is unclear why this gap is still waiting to be culturally and practically filled, especially knowing that the standardized mortality ratio by age is significantly increased after the major types of osteoporotic fractures. It is highly likely that osteoporosis (OP)-related fractures are still undertreated due to misinformation on adequate approaches to patient care and discrepancies existing between treatment guidelines. To overpass such inadequacies, the multitask force of the American Society for Bone and Mineral Research (ASBMR) has recently provided clinical recommendations for optimal prevention of secondary fracture among people aged > 65 years with hip or vertebral fractures [5] (Fig. 1). Clinical questions raised by authors and treatment recommendations are even more important than in the past, given the challenges and restrictions for bone fragility care imposed by the pandemic.