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      Osteoporosis Management in the Era of COVID‐19

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          ABSTRACT

          Osteoporosis is a chronic condition that reflects reduced bone strength and an associated increased risk for fracture. As a chronic condition, osteoporosis generally requires sustained medical intervention(s) to limit the risks for additional bone loss, compromise of skeletal integrity, and fracture occurrence. Further complicating this issue is the fact that the abrupt cessation of some therapies can be associated with an increased risk for harm. It is in this context that the COVID‐19 pandemic has brought unprecedented disruption to the provision of health care globally, including near universal requirements for social distancing. In this Perspective, we provide evidence, where available, regarding the general care of patients with osteoporosis in the COVID‐19 era and provide clinical recommendations based primarily on expert opinion when data are absent. Particular emphasis is placed on the transition from parenteral osteoporosis therapies. It is hoped that these recommendations can be used to safely guide care for patients with osteoporosis until a return to routine clinical care standards is available. © 2020 American Society for Bone and Mineral Research.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Hematological findings and complications of COVID ‐19

            Evangelos Terpos, Ioannis Ntanasis-Stathopoulos, Ismail Elalamy … (2020)
            Abstract COVID‐19 is a systemic infection with a significant impact on the hematopoietic system and hemostasis. Lymphopenia may be considered as a cardinal laboratory finding, with prognostic potential. Neutrophil/lymphocyte ratio and peak platelet/lymphocyte ratio may also have prognostic value in determining severe cases. During the disease course, longitudinal evaluation of lymphocyte count dynamics and inflammatory indices, including LDH, CRP and IL‐6 may help to identify cases with dismal prognosis and prompt intervention in order to improve outcomes. Biomarkers, such high serum procalcitonin and ferritin have also emerged as poor prognostic factors. Furthermore, blood hypercoagulability is common among hospitalized COVID‐19 patients. Elevated D‐Dimer levels are consistently reported, whereas their gradual increase during disease course is particularly associated with disease worsening. Other coagulation abnormalities such as PT and aPTT prolongation, fibrin degradation products increase, with severe thrombocytopenia lead to life‐threatening disseminated intravascular coagulation (DIC), which necessitates continuous vigilance and prompt intervention. So, COVID‐19 infected patients, whether hospitalized or ambulatory, are at high risk for venous thromboembolism, and an early and prolonged pharmacological thromboprophylaxis with low molecular weight heparin is highly recommended. Last but not least, the need for assuring blood donations during the pandemic is also highlighted.
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              Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis.

              R M Neer, C Arnaud, J. Zanchetta … (2001)
              Once-daily injections of parathyroid hormone or its amino-terminal fragments increase bone formation and bone mass without causing hypercalcemia, but their effects on fractures are unknown. We randomly assigned 1637 postmenopausal women with prior vertebral fractures to receive 20 or 40 microg of parathyroid hormone (1-34) or placebo, administered subcutaneously by the women daily. We obtained vertebral radiographs at base line and at the end of the study (median duration of observation, 21 months) and performed serial measurements of bone mass by dual-energy x-ray absorptiometry. New vertebral fractures occurred in 14 percent of the women in the placebo group and in 5 percent and 4 percent, respectively, of the women in the 20-microg and 40-microg parathyroid hormone groups; the respective relative risks of fracture in the 20-microg and 40-microg groups, as compared with the placebo group, were 0.35 and 0.31 (95 percent confidence intervals, 0.22 to 0.55 and 0.19 to 0.50). New nonvertebral fragility fractures occurred in 6 percent of the women in the placebo group and in 3 percent of those in each parathyroid hormone group (relative risk, 0.47 and 0.46, respectively [95 percent confidence intervals, 0.25 to 0.88 and 0.25 to 0.861). As compared with placebo, the 20-microg and 40-microg doses of parathyroid hormone increased bone mineral density by 9 and 13 more percentage points in the lumbar spine and by 3 and 6 more percentage points in the femoral neck; the 40-microg dose decreased bone mineral density at the shaft of the radius by 2 more percentage points. Both doses increased total-body bone mineral by 2 to 4 more percentage points than did placebo. Parathyroid hormone had only minor side effects (occasional nausea and headache). Treatment of postmenopausal osteoporosis with parathyroid hormone (1-34) decreases the risk of vertebral and nonvertebral fractures; increases vertebral, femoral, and total-body bone mineral density; and is well tolerated. The 40-microg dose increased bone mineral density more than the 20-microg dose but had similar effects on the risk of fracture and was more likely to have side effects.
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                Author and article information

                Contributors
                Matthew T Drake:
                ORCID: https://orcid.org/0000-0002-3662-7345
                drake.matthew@mayo.edu
                Journal
                Journal ID (nlm-ta): J Bone Miner Res
                Journal ID (iso-abbrev): J. Bone Miner. Res
                Journal ID (doi): 10.1002/(ISSN)1523-4681
                Journal ID (publisher-id): JBMR
                Title: Journal of Bone and Mineral Research
                Publisher: John Wiley & Sons, Inc. (Hoboken, USA )
                ISSN (Print): 0884-0431
                ISSN (Electronic): 1523-4681
                Publication date (Electronic): 26 May 2020
                Electronic Location Identifier: 10.1002/jbmr.4049
                Affiliations
                [ 1 ] Endocrine Unit Massachusetts General Hospital/Harvard Medical School Boston MA USA
                [ 2 ] Department of Medicine III Universitätsklinikum Dresden Dresden Germany
                [ 3 ] Center for Healthy Aging Universitätsklinikum Dresden Dresden Germany
                [ 4 ] Division of Endocrinology, Diabetes, Metabolism, and Nutrition Mayo Clinic Rochester MN USA
                [ 5 ] Department of Medicine University of California, San Francisco San Francisco CA USA
                [ 6 ] Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco CA USA
                [ 7 ] Robert and Arlene Kogod Center on Aging Mayo Clinic Rochester MN USA
                Author notes
                [*] [* ]Address correspondence to: Matthew T Drake, MD, PhD, Division of Endocrinology and Kogod Center on Aging, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. E‐mail: drake.matthew@ 123456mayo.edu
                Author information
                https://orcid.org/0000-0003-0633-0839
                https://orcid.org/0000-0002-3801-9546
                https://orcid.org/0000-0001-5261-7721
                https://orcid.org/0000-0002-3662-7345
                Article
                Publisher ID: JBMR4049
                DOI: 10.1002/jbmr.4049
                PMC ID: 7273005
                PubMed ID: 32406536
                SO-VID: 6dd622ca-40d7-4aae-b7b1-3aa128ce515b
                Copyright © © 2020 American Society for Bone and Mineral Research
                License:

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Date received : 28 April 2020
                Date revision received : 06 May 2020
                Date accepted : 08 May 2020
                Page count
                Figures: 0, Tables: 0, Pages: 5, Words: 5351
                Categories
                Subject: Perspective
                Subject: Perspectives
                Custom metadata
                source-schema-version-number 2.0
                edited-state corrected-proof
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.3 mode:remove_FC converted:05.06.2020

                ScienceOpen disciplines: Human biology
                Keywords: abaloparatide,bisphosphonat,covid‐19,denosumab,fractures,osteoporosis,romosozumab,teriparatide
                Data availability:
                ScienceOpen disciplines: Human biology
                Keywords: abaloparatide, bisphosphonat, covid‐19, denosumab, fractures, osteoporosis, romosozumab, teriparatide

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