The impact of the COVID-19 pandemic on osteoporotic fractures: a systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis examined observational or retrospective studies comparing osteoporotic fracture incidence in 2020 with 2019. Nine studies were included. Overall fracture incidence was lower during the pandemic (RR = 0.85, 95% CI 0.80-0.91, p < 0.0001), with a significant reduction in forearm fractures. Globally, the analysis found no statistically significant change in hip or vertebral fractures. Hip fracture incidence decreased in South America, while no significant change was observed in Europe. The findings indicate that pandemic-period changes varied by fracture type and region.

Key findings

• Overall osteoporotic fracture incidence decreased during 2020 compared with 2019 (RR = 0.85, 95% CI 0.80-0.91, p < 0.0001).
• Forearm fractures decreased (RR = 0.87, 95% CI 0.79-0.96, p = 0.002).
• No statistically significant global change was found for hip fractures (RR = 0.93, 95% CI 0.76-1.15, p = 0.14) or vertebral fractures (RR = 1.35, 95% CI 0.85-2.15, p = 0.20).
• Hip fracture incidence decreased in South America (RR = 0.79, p = 0.0004), whereas Europe showed no significant change (RR = 0.92, 95% CI 0.81-1.04, p = 0.17).

Why it matters

The results distinguish reductions in overall and forearm fracture incidence from the absence of a statistically significant global change in hip and vertebral fractures. This suggests that pandemic-associated shifts in activity or care may not have affected fracture types uniformly. Regional variation also cautions against assuming that findings from one setting apply across populations.

What to keep in mind

The review included nine observational or retrospective studies comparing only 2020 with 2019, so the findings are vulnerable to limitations of the underlying studies and do not establish that the pandemic caused the observed changes.