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      Recomendaciones conjuntas sobre el manejo del paciente con osteoporosis y/o fracturas por fragilidad durante y después de la pandemia por COVID-19 de la SEIOMM, SEFRAOS, SER, SEMI, SEGG, SEMG, SEMERGEN y SEEN Translated title: Joint recommendations on the management of patients with osteoporosis and/or fragility fractures during and after the pandemic due to COVID-19 of SEIOMM, SEFRAOS, SER, SEMI, SEGG, SEMG, SEMERGEN and SEEN

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          Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

          Objectives To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. Design Systematic review. Eligibility Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19. Data sources PubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact. Data analysis Risk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis. Outcome measures Primary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores). Results 3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference. Conclusions Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery. PROSPERO registration number CRD42020203729.
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            COVID-19-Related Severe Hypercoagulability in Patients Admitted to Intensive Care Unit for Acute Respiratory Failure

            In late December 2019 an outbreak of a novel coronavirus (SARS-CoV-2) causing severe pneumonia (COVID-19) was reported in Wuhan, Hubei Province, China. A common finding in most COVID-19 patients is high D-dimer levels which are associated with a worse prognosis. We aimed to evaluate coagulation abnormalities via traditional tests and whole blood thromboelastometry profiles in a group of 22 (mean age 67 ± 8 years, M:F 20:2) consecutive patients admitted to the Intensive Care Unit of Padova University Hospital for acute respiratory failure due to COVID-19. Cases showed significantly higher fibrinogen and D-dimer plasma levels versus healthy controls ( p  < 0.0001 in both comparisons). Interestingly enough, markedly hypercoagulable thromboelastometry profiles were observed in COVID-19 patients, as reflected by shorter Clot Formation Time (CFT) in INTEM ( p  = 0.0002) and EXTEM ( p  = 0.01) and higher Maximum Clot Firmness (MCF) in INTEM, EXTEM and FIBTEM ( p  < 0.001 in all comparisons). In conclusion, COVID-19 patients with acute respiratory failure present a severe hypercoagulability rather than consumptive coagulopathy. Fibrin formation and polymerization may predispose to thrombosis and correlate with a worse outcome.
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              Vertebral Fractures After Discontinuation of Denosumab: A Post Hoc Analysis of the Randomized Placebo-Controlled FREEDOM Trial and Its Extension.

              Denosumab reduces bone resorption and vertebral and nonvertebral fracture risk. Denosumab discontinuation increases bone turnover markers 3 months after a scheduled dose is omitted, reaching above-baseline levels by 6 months, and decreases bone mineral density (BMD) to baseline levels by 12 months. We analyzed the risk of new or worsening vertebral fractures, especially multiple vertebral fractures, in participants who discontinued denosumab during the FREEDOM study or its Extension. Participants received ≥2 doses of denosumab or placebo Q6M, discontinued treatment, and stayed in the study ≥7 months after the last dose. Of 1001 participants who discontinued denosumab during FREEDOM or Extension, the vertebral fracture rate increased from 1.2 per 100 participant-years during the on-treatment period to 7.1, similar to participants who received and then discontinued placebo (n = 470; 8.5 per 100 participant-years). Among participants with ≥1 off-treatment vertebral fracture, the proportion with multiple (>1) was larger among those who discontinued denosumab (60.7%) than placebo (38.7%; p = 0.049), corresponding to a 3.4% and 2.2% risk of multiple vertebral fractures, respectively. The odds (95% confidence interval) of developing multiple vertebral fractures after stopping denosumab were 3.9 (2.1-7. 2) times higher in those with prior vertebral fractures, sustained before or during treatment, than those without, and 1.6 (1.3-1.9) times higher with each additional year of off-treatment follow-up; among participants with available off-treatment total hip (TH) BMD measurements, the odds were 1.2 (1.1-1.3) times higher per 1% annualized TH BMD loss. The rates (per 100 participant-years) of nonvertebral fractures during the off-treatment period were similar (2.8, denosumab; 3.8, placebo). The vertebral fracture rate increased upon denosumab discontinuation to the level observed in untreated participants. A majority of participants who sustained a vertebral fracture after discontinuing denosumab had multiple vertebral fractures, with greatest risk in participants with a prior vertebral fracture. Therefore, patients who discontinue denosumab should rapidly transition to an alternative antiresorptive treatment. Clinicaltrails.gov: NCT00089791 (FREEDOM) and NCT00523341 (Extension). © 2017 American Society for Bone and Mineral Research.
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                Author and article information

                Journal
                romm
                Revista de Osteoporosis y Metabolismo Mineral
                Rev Osteoporos Metab Miner
                Sociedad Española de Investigaciones Óseas y Metabolismo Mineral (Madrid, Madrid, Spain )
                1889-836X
                2173-2345
                June 2022
                : 14
                : 2
                : 69-73
                Affiliations
                [10] Valencia orgnameCentro Fontanars dels Alforins orgdiv1Departamento Salud Xátiva-Ontinyent
                [11] orgnameHospital General Universitario de Ciudad Real orgdiv1Servicio de Endocrinología y Nutrición
                [02] Barcelona orgnameUniversidad de Barcelona orgdiv1Hospital Clínic orgdiv2Servicio de Reumatología
                [07] orgnameHospital General Universitario de Elche orgdiv1Servicio de Medicina Interna
                [06] Barcelona orgnameUniversidad de Barcelona orgdiv1Hospital Clínic orgdiv2Servicio de Reumatología
                [09] Pontevedra orgnameCentro de Salud de Marín
                [04] Sabadell orgnameHospital Universitari Parc Taulí orgdiv1Servicio de Reumatología
                [08] orgnameConsorci Sanitari de Terrassa orgdiv1Servicio de Geriatría
                [05] Santiago de Compostela orgnameComplejo Hospitalario Universitario de Santiago de Compostela orgdiv1Servicio de Cirugía Ortopédica y Traumatología
                [01] Oviedo orgnameHospital Universitario Central de Asturias orgdiv1Unidad de Gestión Clínica de Metabolismo Óseo orgdiv2ISPA
                [03] Seville Andalucía orgnameUniversidad de Sevilla orgdiv1Departamento de Medicina Spain
                Article
                S1889-836X2022000200002 S1889-836X(22)01400200002
                10.4321/s1889-836x2022000200002
                a51cd81e-e829-4778-a04b-ddaf41da2c88

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 08 November 2021
                : 04 November 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 5
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