COVID-19 lockdown negatively impacted on adherence to denosumab therapy: incidence of non-traumatic fractures and role of telemedicine.

PURPOSE: Coronavirus disease (COVID-19) lockdowns have impacted on management of osteoporosis and the use of telemedicine is increasingly widespread albeit supported by little evidence so far. The aim of the study is to assess adherence to denosumab and incidence of non-traumatic fractures during the lockdown compared to the pre-COVID-19 year and to explore the effectiveness of telemedicine in the management of osteoporotic patients. 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). Data on new fractures, adherence, risk factors for osteoporosis and the modality of visit (telemedicine or face-to-face) were collected. RESULTS: The prevalence of non-adherent patients was higher during the lockdown (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 higher than the pre-COVID-19 year (p < 0.0001): 10 patients out of 269 (3.7%) experienced a fragility fracture and 2 patients (0.7%) a probable rebound fracture during the lockdown period, whereas no patient had fragility/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. CONCLUSION: Non-adherent patients and new non-traumatic fractures (including rebound fractures) were more prevalent during the lockdown in comparison to the pre-COVID-19 period, regardless of the modality of medical evaluation.

Integrated study and application of polymer injection in arctic environment

This work presents the interpretation of a polymer injectivity test performed in a heavy-oil field (50-200 cP), located in a challenging arctic environment, during the first half of 2019 to assess the feasibility of the polymer injection process. Following the positive results achieved with the injectivity test, a polymer interwell pilot test started in the last months of 2019, but it was suspended in April 2020 due to Covid restrictions. Thanks to the acquired data during the pilot test, polymer model was tuned into a dedicated sector of the reservoir model, including one injector and two producers. Using internal company EOR-screening tools, polymer flooding was identified as the most suitable technology for the asset. An integrated study of 3D-modeling and in-house laboratory activities was performed to assess polymer injection potentialities and select the best chemical product for the asset. 3D dynamic analyses confirm the benefits of polymer injection with a significant oil production gain. Four representative horizontal wells were selected for the injectivity test in order to confirm the injection effectiveness. The selection of injectors was based on an extensive analyses of wells status and performance. The test strategy consisted of 2-weeks polymer injection per well, at constant injection rate and increasing polymer concentration steps. A detailed real-Time surveillance plan was realized to monitor injector pressures and polymer solution properties. The injectivity test was concluded successfully: Target viscosity, defined during the laboratory and modeling analyses, was achieved with a limited impact on injectivity. Pressure increase and stabilization during polymer injection confirmed the feasibility of the technique for the reservoir. Well test and temperature profile acquired before and after polymer injection were interpreted. Once assessed the feasibility of polymer injectivity, a 1-year inter-well pilot started in November 2019. Injection took place up to March 2020 and was suspended due to Covid restrictions. The re-start is planned for mid-2021. During the test several injection and production data were gathered, analyzed and interpreted. In addition to that, starting from the full reservoir model, a detailed sector model was set up in order to match pressures and water cut and forecast the performances of polymer injection. © IOR 2021 - 21st European Symposium on Improved Oil Recovery.