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Guidance on Osteoporosis Management during Covid 19

1 June 2020

Joint guidance has been issued by five leading bone health organisations in America offering both general and specific recommendations for patients whose osteoporosis treatment plan is either continuing or has been disrupted during the Covid-19 pandemic.

Recommendations from the American Society for Bone and Mineral Research (ASBMR), the American Association of Clinical Endocrinologists, the Endocrine Society, the European Calcified Tissue Society, and the National Osteoporosis Foundation include taking no risks if you are at high risk from fracture.

The initiation of oral bisphosphonate therapy can be done via telephone or video visit and should not be delayed in patients at high risk for fracture (for example: in patients who have recently sustained an osteoporotic fragility fracture).

Bone mineral density (BMD) examinations may need to be postponed when public health guidance recommends the halting of elective procedures.

For patients already on osteoporosis medications - such as oral and IV bisphosphonates, denosumab, estrogen, raloxifene, teriparatide, abaloparatide, and romosozumab - they recommend continuing treatment whenever possible. "There is no evidence that any osteoporosis therapy increases the risk or severity of Covid-19 infection or alters the disease course," they stated. However, they did say Covid-19 may increase the risk of hypercoagulable complications (increased blood clot risk) and so caution should be exercised for patients being treated for Covid 19 if taking oral estrogen or raloxifene, both of which can also increase risk of blood clot. In this situation, consideration should be given to changing to transdermal estrogen, or a different type of treatment for osteoporosis treatment.
Patients taking treatments which are given by a healthcare professional may experience delay in receiving treatments, delays of even several months are unlikely to be harmful, but re-evaluation is required.

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