Joint Guidance issued by societies for management of osteoporosis during COVID-19 era

A league of experts from the Endocrine Society, European Calcified Tissue Society (ECTS), American Society for Bone and Mineral Research (ASBMR), American Association of Clinical Endocrinologists (AACE), and National Osteoporosis Foundation (NOF) formed a joint guidance statement about the management of osteoporosis during the coronavirus disease 2019 pandemic.

As the need of the hour is primarily social distancing which could possibly obstruct the osteoporosis treatment, therefore, the experts proposed that the physicians should keep the following points in mind:

• Initiation of bisphosphonate oral therapy should not be delayed for high-risk patients for fracture. Telemedicine can be put to practice for the appointments for the same.
• Caution should be used in case of estrogen and raloxifene therapy, as they are most likely to cause hypercoagulable complications associated with COVID-19, linked to a modest increase in thrombotic risk.
• Given the potential risk of hypercoagulable complications concerned with COVID-19 due to the estrogen and raloxifene therapy for osteoporosis, caution needs to be taken.
• Bone mineral density tests may be postponed
• If the preceding year results were within the normal range, the usual pretreatment laboratory measurements for intravenous (IV) bisphosphonates or denosumab can be avoided. Although in patients with unstable renal function and at an increased hypocalcemia risk, it can be done.
• Opt for other ways of parenteral osteoporosis medication. Use of off-site hospitals, home delivery and administration from a healthcare professional, drive-through or self-injection can be useful.

• For patients who are unable to receive their prescribed routine of:

- Denosumab, they should be provisionally transitioned to oral bisphosphonates if the time from last injection surpasses 7 months (ie, a 1-month delay). Patients with underlying gastrointestinal disorders can benefit from ibandronate (monthly dose) and risedronate (weekly/monthly dose). Patients with chronic renal insufficiency can benefit from oral bisphosphonates (low-dose)

- Romosozumab, Teriparatide or Abaloparatide, consider a treatment delay. If this delay exceeds 2 to 3 months, switch to oral bisphosphonates provisionally.

- IV bisphosphonates, consider a treatment delay. This delay for months is doubtfully harmful.

As the magnitude of the COVID-19 is exceptional, these guidelines may help the healthcare professionals to adjust treatment for patients to oral bisphosphonates helpful both for the physicians and their patients.