Management of osteoporosis during martial law: the experience of the Ukrainian Center of Osteoporosis and the challenges of war

Abstract

Background. Russian aggression has had a critical impact on the provision of medical care to the patients in Ukraine, in general, and to the patients with osteoporosis and its complications, in particular. Destruction of hospitals, limited access to emergency and planned medical care, and increased workload on some hospitals due to a significant number of refugees and internally displaced persons are only some of the problems faced by the Ukrainian medical community. The purpose of the study was to analyze the peculiarities of providing diagnostic and advisory care at the Ukrainian Scientific and Medical Center of Osteoporosis (Kyiv) during martial law in order to determine the main challenges associated with military aggression and the possibilities of their elimination. Materials and me­thods. In a retrospective analysis of the data, the Center’s activity during 2019–2022 was evaluated depending on the month and year of the observation, the age and gender of the examinees, and type of the patients’ visit (on-line or off-line). Results. The analysis confirmed the decrease in dual-energy X-ray absorptiometry (DXA) procedures and consultations of various specialists from the beginning of martial law in Ukraine. The resumption of the Center’s work, despite difficulties related to logistical and other reasons, took place after 2 weeks in the on-line format and in 1.5 months after the start of martial law (off-line). Despite the decrease in the number of DXA procedures (by 84.3 % in April and 24.7 % in May 2022 compared to the indices in the same months in 2019) and off-line consultations (by 93.6 % in March, 66 % in April, and 11.2 % in May 2022 compared to the indices of 2019) during the martial law, the Center’s work was characterized by the implementation of on-line consultations, the share of which in the first months after the russian invasion was 66–100 % of all consultations. Conclusions. Well-established work using teleme­dicine allows maintaining the provision of medical care to the patients with osteoporosis and its complications at an appropriate level despite the challenges associa­ted with martial law.