To mask or not to mask: Prevention of osteoporotic fractures: lessons from the COVID-19 pandemic

ABSTRACT

While it is increasingly evident that preventing secondary fractures can be a feasible and cost-effective task through active steps taken on those identified at higher risk, after suffering a fragility fracture;the burden in morbidity, mortality, and resources needed for acute and chronic care, still will be significant. Patients with fragility fractures requiring attention in a hospital, may not be overwhelming in terms of space and resources needed-as the COVID-19 pandemic-but, as the population ages and the prevalence of osteoporosis grows, the tendency is clearly upwards. Are there realistic interventions to decrease the number or first fragility fracture (FFF) at the population level? Since the early days of the COVID-19 pandemic, proposals to control its burden included ideas on accelerating preparedness on testing, personal protection, and tools to help in medical decisions;on mitigation of the burden of social distancing;on the use of digital technologies, like Tele-Health and artificial intelligence to notify those at risk;on adaptations of legal, regulatory, and support framework;on the need to invest and support innovators and on the need to improve communications on these topics1. In the case of osteoporosis, some of these thoughts may help. We can improve preparedness by broadening the involvement of primary care physicians on detection with simple tools and, if possible, access to DXA. Well informed health professionals may increase awareness among general population on the disease and how to help it. Involvement of the community in identifying those at higher risk, through a broader use of digital technologies and artificial intelligence seems feasible, now that the community sees as normal, a number of intrusive activities. If the world wide web allows a number of entities to identify potential customers, it can certainly provide clues on identification of candidates to be tested. This will require reviews of the legal basis for some of the required actions. There is a need to create sources of funding to support innovators on the design of new approaches-beyond pharmacological developments-for the prevention of osteoporotic fractures and their burden. All of these ideas require a massive distribution through strong communication efforts. The SCOOP study demonstrated that a systematic, community-based screening program of fracture risk in older women brought a significant improvement in terms of prevention of fractures2. A number of lifestyle changes may also have a positive impact in the community, with low cost3. These are only 2 of the many concepts that may find a way in our communication developments to decrease the burden of fragility fractures.