Endocrine Abstracts

Background: Adherence to anti-osteoporotic therapy is fundamental to prevent harmful consequences including fragility fractures and, in the specific case of denosumab discontinuation, of rebound fractures. Coronavirus disease (Covid-19) lockdowns have impacted on management of osteoporosis, but data about adherence to denosumab and rebound fractures during the Covid-19 pandemic are still lacking. The use of telemedicine is increasingly widespread albeit supported by little evidence so far.

Aim: To assess adherence to denosumab and incidence of non-traumatic fractures (fragility and rebound) during the lockdown year compared to the pre-Covid-19 year. Thereafter, this study aims to investigate the effectiveness of telemedicine in the management of osteoporotic patients with ongoing denosumab treatment.

Methods: Retrospective, longitudinal, single-center study on patients receiving subcutaneous denosumab therapy every 6 months. Each patient was scheduled to undergo 2 visits: one during the pre-Covid-19 period (March 2019 – March 2020) and another visit during the lockdown period (March 2020 – March 2021). Adherence was defined as being punctual (with an allowable delay of up to 4 weeks) with the injection scheduled 6 months after the previous dose. Data on new fractures, risk factors for osteoporosis and the modality of visit (telemedicine or face-to-face) were collected. Statistical analysis: Mann-Whitney and Chi-Square tests were used to compare continuous and categorical variables, while logistic regressions were used to detect factors associated with non-adherence/new fractures.

Results: The prevalence of non-adherent patients was significantly higher in the lockdown period (35 of 269 patients, 13.0%) than the pre-Covid-19 period (9 of 276 patients, 3.3%) (P<0.0001). During the lockdown the number of new non-traumatic fractures was significantly higher than the pre-Covid-19 year (P<0.0001). In particular, 10 patients out of 269 (3.7%) experienced a fragility fracture and 2 patients (0.7%) a rebound fracture during the lockdown period, whereas no patient had fragility or rebound fractures during the pre-Covid-19 period. No difference was found in the prevalence of non-adherence and new non-traumatic fractures comparing patients evaluated with tele-medicine to those evaluated with face-to-face visit.

Conclusions: Non-adherent patients and new non-traumatic fractures (including rebound fractures) were more prevalent during the lockdown period in comparison to the pre-Covid-19 period, regardless of the modality of medical evaluation. Tele-medicine seems to be an alternative strategy to standard face-to-face visits, in guaranteeing the continuity of follow-up in osteoporotic patients and short-term compliance to Denosumab