A pragmatic proposal for triaging DXA testing during the COVID-19 global pandemic
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A pragmatic proposal for triaging DXA testing during the COVID-19 global pandemic H.R. Sapkota 1
&
A. Nune 2
&
J. Bateman 1 & S. Venkatachalam 1
Received: 17 July 2020 / Accepted: 28 October 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract The COVID-19 pandemic has resulted in huge disruption to healthcare provision, including to dual-energy X-ray absorptiometry (DXA) imaging. Increased waiting lists for DXA from the pandemic mean potential long and uncertain delays in treatment for osteoporosis. To address these increased waiting lists, we propose a rapid, simple, one-stop algorithm incorporating medication use (aromatase inhibitor, corticosteroid) and clinical risk stratification supplementing a standard FRAX assessment. Our pragmatic algorithm produces a recommendation to treat empirically, image with DXA, or observe. If applied, we model a significant reduction in DXA scan requirements with a corresponding reduction in treatment delays for those awaiting DXA. We estimate this will reduce DXA scan numbers by about 50%, whilst pragmatically ensuring those with the highest clinical need correctly receive treatment without delay. This algorithm will help many clinicians including general practitioners/family physicians prioritise DXA when they may not always have the expertise to make this judgement based on clinical information alone. Although we have used UK guidelines as an example, this approach is flexible enough for adaptation by other countries based on their local guidelines, licensing, prescribing requirements, and DXA waiting list times. There are some limitations to our proposal. However, it represents one way of managing the uncertainty of the current COVID-19 pandemic. Keywords BMD . COVID-19 . DXA . FRAX . Osteoporosis
Introduction Significant healthcare disruptions due to the COVID-19 pandemic may continue for several months or even years. In the UK, routine outpatient appointments and investigations have been delayed due to the COVID-19 pandemic. Consequently, there is a prolonged wait for DXA scans due to the coronavirus restrictions in the UK. DXA is an important investigation * H.R. Sapkota [email protected] A. Nune [email protected] J. Bateman [email protected] S. Venkatachalam [email protected] 1
The Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton WV10 0QP, UK
2
Southport and Ormskirk NHS Trust, Southport PR8 6PN, UK
in the management of patients with osteoporosis but it is not essential for the diagnosis [1]. In December 2019 in England, 29,972 patients were waiting for a DXA, whereas after the lockdown in June 2020, this number had gone up by 50% to 45,072. Compared to June 2019, 73% fewer DXA scans were carried out in June 2020, which illustrates the scale of disruption caused by the COVID-19 pandemic [2]. The extent of disruption in delivering the DXA service may vary in different countries depending on the local prevalence of COVID-19 and healthcare delivery. We anticipate that DXA services
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