COVID-19 & FLS centers

To all CTF / FLS centers :
The COVID-19 epidemic is imposing a major burden on hospitals and health care professionals, causing some disruptions in the usual care of patients with non-COVID disorders, including potentially patients with fragility fractures. In many cases, doctors and nurses have been redeployed to take care of COVID patients, and the rehabilitation processes interrupted or at least minimized, disrupting FLS pathways.
Yet the mid- and long-term prevention of secondary fractures remains important, since the mortality and morbidity associated with those fractures in the end is at least as high as for COVID patients and the avoidable recurrent fractures in the imminent risk period only add to the already overloaded hospital systems. In those exceptional circumstances, we encourage FLS centers to adopt the following simplified procedure:
1.    Establish an automated order in the trauma / orthopaedic center to inititiate appropriate osteoporosis therapy within 48 hrs post- surgery and in any case before discharge from the orthopaedic ward to eligible* patients above 60 with a major fragility fracture of the hip, spine, humerus and pelvis and in absence of contra-indications.
2.    Keep a list of those patients with fragility fractures for further evaluation and treatment once services start going back to normal, ideally within 6 months after the fracture.

*Precautions for use of anti-osteoporotic medications:
•    Patients are required to have a normal adjusted serum calcium and be calcium and vitamin D replete, usually taken as a serum 25OH vitamin D of at least 50 nmol/L.
•    Zoledronate is contra-indicated in those with a creatinine clearance of <35ml/min.
•    Denosumab is cautioned in those with a creatinine clearance of <35 ml/min or receiving dialysis and should be managed according to local guidelines. Stopping Denosumab after 6 months may lead to rapid bone loss and elevated fracture risk.
•    Other drugs are contra-indicated in those with a creatinine clearance of <30ml/mn