{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T15:49:52Z","timestamp":1777045792609,"version":"3.51.4"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,4,9]],"date-time":"2024-04-09T00:00:00Z","timestamp":1712620800000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT-16913"],"award-info":[{"award-number":["PJT-16913"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AG078759"],"award-info":[{"award-number":["R01AG078759"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006085","name":"Office of Disease Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006085","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CIHR Canada Graduate Scholarship"},{"name":"Leslie Dan Faculty of Pharmacy Dean\u2019s Graduate Admissions Award"},{"name":"Drug Safety and Effectiveness Cross-disciplinary Training (DSECT) Program"},{"name":"Tier 1 Canada Research Chair in Musculoskeletal and Postmenopausal Health"},{"name":"Tier 2 Canada Research Chair in Drug Policy Research & Evaluation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Timely administration of denosumab every 6\u00a0mo is critical in osteoporosis treatment to avoid multiple vertebral fracture risk upon denosumab discontinuation or delay. This study aimed to estimate the immediate and prolonged impact of the COVID-19 pandemic on the timing of denosumab doses. We identified older adults (\u226566\u00a0yr) residing in the community who were due to receive denosumab between January 2016 and December 2020 using Ontario Drug Benefit data. We completed an interrupted time-series analysis to estimate the impact of the COVID-19 pandemic (March 2020) on the monthly proportion of on-time denosumab doses (183 +\/\u221230\u00a0d). Analyses were stratified by user type: patients due for their second dose (novice users), third or fourth dose (intermediate users), or\u00a0\u22655th dose (established users). In additional analyses, we considered patients living in nursing homes, switching to other osteoporosis drugs, and reported trends until February 2022. We studied 148\u2009554 patients (90.9% female, mean [SD] age 79.6 [8.0] yr) receiving 648\u2009221 denosumab doses. The average pre-pandemic proportion of on-time therapy was steady in the community, yet differed by user type: 64.9% novice users, 72.3% intermediate users, and 78.0% established users. We identified an immediate overall decline in the proportion of on-time doses across all user types at the start of the pandemic: \u221217.8% (95% CI, \u221219.6, \u221216.0). In nursing homes, the pre-pandemic proportion of on-time therapy was similar across user types (average 83.5%), with a small decline at the start of the pandemic: \u22123.2% (95% CI, \u22125.0, \u22121.2). On-time therapy returned to pre-pandemic levels by October 2020 and was not impacted by therapy switching. Although on-time dosing remains stable as of February 2022, approximately one-fourth of patients in the community do not receive denosumab on-time. In conclusion, although pandemic disruptions to denosumab dosing were temporary, levels of on-time therapy remain suboptimal.<\/jats:p>","DOI":"10.1093\/jbmrpl\/ziae027","type":"journal-article","created":{"date-parts":[[2024,4,9]],"date-time":"2024-04-09T11:09:30Z","timestamp":1712660970000},"source":"Crossref","is-referenced-by-count":5,"title":["On-time denosumab dosing recovered rapidly during the COVID-19 pandemic, yet remains suboptimal"],"prefix":"10.1093","volume":"8","author":[{"given":"Anna M","family":"Rzepka","sequence":"first","affiliation":[{"name":"Leslie Dan Faculty of Pharmacy , Graduate Department of Pharmaceutical Sciences, , Toronto, ON M5S 3M2 , Canada"},{"name":"University of Toronto , Graduate Department of Pharmaceutical Sciences, , Toronto, ON M5S 3M2 , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela M","family":"Cheung","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health , Institute of Health Policy, Management and Evaluation, , Toronto, ON M5T 3M7 , Canada"},{"name":"University of Toronto , Institute of Health Policy, Management and Evaluation, , Toronto, ON M5T 3M7 , Canada"},{"name":"Department of Medicine, University Health Network, University of Toronto , Toronto, ON M5G 2C4 , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Kim","sequence":"additional","affiliation":[{"name":"Leslie Dan Faculty of Pharmacy , Graduate Department of Pharmaceutical Sciences, , Toronto, ON M5S 3M2 , Canada"},{"name":"University of Toronto , Graduate Department of Pharmaceutical Sciences, , Toronto, ON M5S 3M2 , Canada"},{"name":"Division of Endocrinology and Metabolism, Women\u2019s College Hospital , Toronto, ON M5S 1B2 , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tara","family":"Gomes","sequence":"additional","affiliation":[{"name":"Leslie Dan Faculty of Pharmacy , Graduate Department of Pharmaceutical Sciences, , Toronto, ON M5S 3M2 , Canada"},{"name":"University of Toronto , Graduate Department of Pharmaceutical Sciences, , Toronto, ON M5S 3M2 , Canada"},{"name":"Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital , Toronto, ON M5B 1W8 , Canada"},{"name":"ICES , Toronto, ON , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne M","family":"Cadarette","sequence":"additional","affiliation":[{"name":"Leslie Dan Faculty of Pharmacy , Graduate Department of Pharmaceutical Sciences, , Toronto, ON M5S 3M2 , Canada"},{"name":"University of Toronto , Graduate Department of Pharmaceutical Sciences, , Toronto, ON M5S 3M2 , Canada"},{"name":"ICES , Toronto, ON , Canada"},{"name":"Dalla Lana School of Public Health , Division of Epidemiology, , Toronto, ON M5T 3M7 , Canada"},{"name":"University of Toronto , Division of Epidemiology, , Toronto, ON M5T 3M7 , Canada"},{"name":"Eshelman School of Pharmacy , Division of Pharmaceutical Outcomes and Policy, , Chapel Hill, NC 27599-7355 , United States"},{"name":"University of North Carolina , Division of Pharmaceutical Outcomes and Policy, , Chapel Hill, NC 27599-7355 , United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,4,9]]},"reference":[{"issue":"8","key":"2024041520145398100_ref1","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1056\/NEJMoa0809493","article-title":"Denosumab for prevention of fractures in postmenopausal women with osteoporosis","volume":"361","author":"Cummings","year":"2009","journal-title":"N Engl J Med"},{"issue":"2","key":"2024041520145398100_ref2","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1002\/jbmr.3337","article-title":"Vertebral fractures after discontinuation of denosumab: a post hoc analysis of the randomized placebo-controlled FREEDOM trial and its extension","volume":"33","author":"Cummings","year":"2018","journal-title":"J Bone Miner Res"},{"issue":"2","key":"2024041520145398100_ref3","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.semarthrit.2019.02.007","article-title":"Spontaneous vertebral fractures after denosumab discontinuation: a case collection and review of the literature","volume":"49","author":"Florez","year":"2019","journal-title":"Semin Arthritis Rheum"},{"issue":"9","key":"2024041520145398100_ref4","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1002\/jbmr.4335","article-title":"Fractures after denosumab discontinuation: a retrospective study of 797 cases","volume":"36","author":"Burckhardt","year":"2021","journal-title":"J Bone Miner Res"},{"issue":"1","key":"2024041520145398100_ref5","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s00223-018-0394-4","article-title":"Bone mineral density changes after 1 year of denosumab discontinuation in postmenopausal women with long-term denosumab treatment for osteoporosis","volume":"103","author":"Popp","year":"2018","journal-title":"Calcif Tissue Int"},{"issue":"10","key":"2024041520145398100_ref6","doi-asserted-by":"crossref","first-page":"e14550","DOI":"10.1111\/ijcp.14550","article-title":"Multiple vertebral fractures after suspension of denosumab. A series of 56 cases","volume":"75","author":"Sosa-Henr\u00edquez","year":"2021","journal-title":"Int J Clin Pract"},{"issue":"6","key":"2024041520145398100_ref7","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1002\/jbmr.3110","article-title":"Clinical features of 24 patients with rebound-associated vertebral fractures after review and additional cases","volume":"32","author":"Anastasilakis","year":"2017","journal-title":"J Bone Miner Res"},{"issue":"4","key":"2024041520145398100_ref8","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s00223-004-2222-2","article-title":"Long-term morbidity and mortality after a clinically diagnosed vertebral fracture in the elderly - a 12- and 22-year follow-up of 257 patients","volume":"76","author":"Hasserius","year":"2005","journal-title":"Calcif Tissue Int"},{"issue":"11","key":"2024041520145398100_ref9","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1001\/archinte.159.11.1215","article-title":"Vertebral 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