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Impact of Covid-19 Pandemic on Pharmacologic Treatment of Patients Newly Diagnosed With Osteoporosis

Micaela White, Lauren Hisatomi, Alex Villegas, Dagoberto Pina, Alec Garfinkel, Garima Agrawal, Nisha Punatar, Barton L. Wise, Polly Teng, Hai Le


This study determined whether initiation of pharmacologic treatment was delayed for newly diagnosed osteoporosis patients during the COVID-19 pandemic.


Osteoporosis is a major public health burden and a systemic skeletal disorder characterized by decreased bone mineral density (BMD) and deterioration of bone architecture [1]. In the United States, approximately 10 million people over the age of 50 have osteoporosis, with an estimated economic burden of $17.9 billion annually [2, 3]. Compromised bone strength increases the risk of fragility fractures, which reduce quality of life while increasing mortality [4, 5]. Consequently, for patients newly diagnosed with osteoporosis, timely pharmacologic treatment is essential to prevent fragility fracture and reduce mortality

Materials and method

Institutional Review Board (IRB) approval from the University of California, Davis, School of Medicine was obtained for this study, and consent was waived by the IRB. This is a retrospective cohort study using review of electronic medical records (EMRs), and all data were fully anonymized before we accessed them for analysis. We evaluated all patients ≥50 years who underwent DXA scanning at a single academic tertiary referral center between March 1, 2018 to January 31, 2022. Each patient’s electronic medical record was reviewed for prior history of osteoporosis by assessing past medical visits, “osteoporosis” ICD diagnoses, previous DXA scans showing low BMD, health records from previous institutions, and self-reported history.


During the study period, 11,335 DXA studies were performed, and we identified 1,189 patients who were newly diagnosed with osteoporosis. There were 576 patients in the pre-pandemic cohort and 613 in the pandemic cohort (Table 1). There was no significant difference between cohorts with regard to age (69.3 vs 68.8 years, p = 0.33), sex (87.0 vs 86.1% female, p = 0.67), or ethnicity (88.7 vs 86.9% Non-Hispanic, p = 0.35). However, there was a higher proportion of White patients in the pre-pandemic cohort (74.3 vs 68.4%, p = 0.02).


The COVID-19 pandemic presented challenges for chronic disease management across medical specialties. This study investigated whether the pandemic had significantly impacted initiation of pharmacologic treatment among patients newly diagnosed with osteoporosis. We found no significant differences in the 3-month and 6-month pharmacologic treatment rates between the pre-pandemic and pandemic cohorts. In addition, the time from osteoporosis diagnosis to therapy initiation and the prescribers were similar between the two cohorts, suggesting that the COVID-19 pandemic did not affect treatment rate or time to treatment.


This is the first study to compare the impact of the COVID-19 pandemic on the pharmacologic treatment of patients who were newly diagnosed with osteoporosis. In our retrospective comparative study, we found only 40.5% of patients with newly diagnosed osteoporosis were treated pharmacologically within six months of diagnosis, and the COVID-19 pandemic did not significantly affect treatment rates. Bisphosphonates were the most often prescribed medication group. Further studies are needed to better understand patient-, provider-, and system-specific factors contributing to the low treatment rates of patients newly diagnosed with osteoporosis.

Citation: White M, Hisatomi L, Villegas A, Pina D, Garfinkel A, Agrawal G, et al. (2023) Impact of COVID-19 pandemic on pharmacologic treatment of patients newly diagnosed with osteoporosis. PLoS ONE 18(9): e0291472.

Editor: Antimo Moretti, University of Campania Luigi Vanvitelli: Universita degli Studi della Campania Luigi Vanvitelli, ITALY

Received: July 12, 2023; Accepted: August 29, 2023; Published: September 13, 2023

Copyright: © 2023 White et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

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