Osteoporosis Canada

PREPARING FOR YOUR VIRTUAL HEALTHCARE APPOINTMENT

Since the COVID-19 lockdown began and even now as things begin to open up across the country, many health professionals have been consulting with their patients on-line or on the phone to maintain social distance and help prevent the spread of the virus. Here are some tips to help you make those appointments more successful. Note that these tips are meant primarily for patients with osteoporosis.

  • Check your email the day before and day of the appointment to make sure there is no change in date or time, or in case information has been sent that is related to your call, and to make sure that your appointment is a virtual one.
  • If someone else is taking part, a relative or friend for support or a translator, make sure they know the date and time. If your appointment is by video (such as Zoom) or teleconference, if they are at another location, they will need to know the video link or the teleconference number.
  • If you are taking the call by phone, be in a safe, secure and quiet place. Do not do it while driving, taking transit, or on the beach. (Yes, people have been known to do this.)
  • If you are being called, pick up the call even if the call display shows an unknown or blocked number.
  • For a healthcare appointment by video, it is especially important to be in a well-lit place, with your face visible, not in front of a bright window.
  • Allow time before and after the stated time in case the healthcare provider is running late.
  • Make a list of questions to discuss ahead of time and have it with you so you don’t forget.
  • Make sure the hospital has your email or phone number.
  • Have close at hand eyeglasses and hearing aid if you use them, pen and paper to make notes, prescription bottles for easy reference, contact information for your pharmacist.

LET THE HEALTHCARE PROVIDER KNOW

  • If you are due for a Prolia® or Evenity® injection or an Aclasta® infusion
  • If you usually have a bone mineral density test before your meeting. This may have been cancelled, and may have to be rescheduled; however, the appointment can go ahead without one
  • If you are having unexplained back pain. This may require a spine x-ray to check for a possible spine fracture
  • If you have any new symptoms or changes in health since your last appointment.

YOUR HEALTHCARE PROVIDER WILL REVIEW WITH YOU

  • Your vitamin D dose
  • Your intake of calcium-rich foods and calcium supplements if you take them
  • Your physical activity or exercise
  • Whether you have fallen since the last visit
  • Whether you have had a new fracture

Whether you have had a new diagnosis or been prescribed a new medication. Some conditions and medications may contribute to bone loss or fall risk. If you are on an osteoporosis medication, are you taking it according to directions and are you experiencing any side effects.

During this lockdown, hospital emergency departments are still open. If you are having an emergency and need help, do not hesitate to go to the emergency department. Do not feel that you must wait for your virtual appointment.

Osteoporosis Drug Treatments & Medication During COVID-19

As we work to adjust to our new normal during COVID-19, now more than ever, staying fracture-free is critical for anyone with osteoporosis. Healthcare systems are over-stretched, with general recommendations urging people to avoid hospitals and doctor’s offices unless absolutely necessary.

  • Prevent Falls: Ensure that your home environment is obstacle free and take care when walking.
  • Do not discontinue any osteoporosis treatment (including calcium and vitamin D supplements) which you have been prescribed. If you have concerns speak to your doctor or pharmacist.
  • Osteoporosis Drug Treatments and COVID-19Osteoporosis Medications – It is recommended that you have at least a one-month supply of your current medications including your osteoporosis medication on hand during this time of social distancing and self-quarantine.
  • If your doctor’s appointment for an injection or infusion of your osteoporosis treatment is cancelled or you’re too unwell to take your medication be sure to contact your doctor and reschedule as soon as possible so that the benefits of treatment are maintained.
  • While we are advised to stay at home, if you are in need of a prescription refill, contact your doctor to arrange a telephone appointment or contact your pharmacist to assist.
  • Ask for help when needed with shopping, getting prescriptions filled, or other errands.

OSTEOPOROSIS ORAL MEDICATION OR SELF-INJECTABLES

If you are taking the following oral medications or self-injectables to treat your osteoporosis, please check with your healthcare provider to make sure you have adequate amounts on hand:

  • Alendronate (brand names: Fosamax®, Fosamax Plus D®)
  • Risedronate (brand names: Actonel®, Actonel DR™)
  • Etidronate (brand names: Didronel®, Didrocal®)
  • Estrogen (multiple brands)
  • Raloxifene (brand name: Evista®)
  • Teriparatide (brand name: Forteo®) If you finish your 2 years of teriparatide or decide to discontinue the medication, please discuss an alternative medication so you do not have bone loss when you stop it.

OSTEOPOROSIS MEDICATIONS ADMINISTERED BY A HEALTHCARE PROVIDER

It is extremely important that patients taking the following medications administered by a healthcare provider stay on time for scheduled injections:

  • Denosumab (brand name Prolia®) – If you skip or delay taking a dose, you have an increased risk for breaking a bone, especially if you already have a broken bone in your spine. Discuss your schedule with your healthcare professional as soon as possible. If you miss or delay a dose of Prolia®, contact your healthcare provider as soon as possible to schedule your next dose. For more detailed information on Denosumab click here
  • Romosozumab (brand name Evenity®) – If you miss or delay a dose of EVENITY®, contact your healthcare provider as soon as possible to schedule your next dose. For more detailed information on Romosozumab click here
  • Zoledronic acid (brand name: Aclasta®): This is normally a once-a-year infusion and can be delayed for a short period of time since the medication lasts a long time. Discuss the schedule with your healthcare professional. For more detailed information on Zoledronic acid and bisphosphonates click here

SELF ADMINISTRATION OF PROLIA AND EVENITY

For two of the medications prescribed for osteoporosis and fracture risk reduction, Evenity® and Prolia®, the recommendation is that they be administered by a healthcare professional. However, in this time of physical distancing and with many doctors’ offices closed, it may be difficult to arrange or keep an appointment.

  • Evenity® is injected monthly. The option of home self-injection is available but this should be discussed with your healthcare provider to make sure it is appropriate for you.
  • Prolia® is injected every six months. It is not recommended to delay more than a month as you risk bone loss and possible fracture. The option of home self-injection is available but this should be discussed with your healthcare provider to make sure it is it is appropriate for you.

Healthcare providers will find detailed instructions for self injection in the product monographs of each medication.For all medications, if you have questions or concerns, be sure to discuss your osteoporosis management and treatment schedule with your healthcare provider.

Whether you are on a medication or not, everyone should strive for adequate calcium intake, preferably from food, and continue with the vitamin D from daily supplementation schedule that was established with your healthcare provider. It is also important to stay active and exercise safely.

WRITTEN BY

Hassan Vatanparast is a member of Osteoporosis Canada’s Scientific Advisory Council.  He is a Professor with Joint Appointment to the College of Pharmacy and Nutrition and School of Public Health, University of Saskatchewan. He is actively involved in research and health promotion initiatives targeting bone health. Hassan is leading several projects at the local, national, and global levels aimed to improve the nutritional health of the general population, newcomers and indigenous communities.

© Osteoporosis Canada, 2021
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