In the era of COVID-19 pandemic, the ASBMR (American Society for Bone and Mineral Research), the NOF (National Osteoporosis Foundation), the AACE (American Association of Clinical Endocrinologists), the Endocrine Society, and the ECTS (European Calcified Tissue Society) united to provide novel general and specific recommendations for treating patients suffering from osteoporosis.

The oral bisphosphonate therapy should be started over either the telephone or through a video visit, with no significant delays for patients at elevated fracture risk. As elective procedures, there may be requisition of postponing bone mineral density assessments. For patients already on osteoporosis medications, treatment should be continued whenever possible.

No clear evidence exists indicating that any osteoporosis therapy modifies the disease course or elevates the severity or risk of SARS-CoV-2 infection. Furthermore, COVID-19 may enhance hypercoagulable complications risk. Therefore, when treating patients with estrogen or raloxifene, caution should be exercised. It is best to discontinue Raloxifene since it is linked with an elevated risk of thromboembolic events linked to COVID-19.

Before IV bisphosphonate and/or denosumab administration, the standard pretreatment labs should be avoided if previous labs were normal and the recent health of the patient demonstrated stability. For patients at elevated risk of developing hypocalcemia and with fluctuating kidney function, lab evaluation is advocated.

For delivering parenteral osteoporosis treatments, the potential alternative methods include home delivery and administration, off-site clinics, self-injection, and drive-through administration of denosumab and/or romosozumab. The complications surrounding each alternative were included residents of socioeconomically challenged communities being unable to reach clinics if public transportation is not available and the important medicolegal issues to evaluate around self-injection.

Experts advocate the frequent reevaluation to resume the original osteoporosis treatment plan once circumstances allow for all subjects whose treatments have been disrupted. The patients who will not be curable within 7 months of their previous injection and are taking denosumab should be immediately shifted to oral bisphosphonates.

For patients with underlying gastrointestinal complications, experts advocate weekly/monthly risedronate or monthly ibandronate. For chronic renal insufficiency patients, an off-label regimen of lower dose oral bisphosphonate is advocated.

For patients who will not be able to obtain continued treatment and who are taking either abaloparatide or teriparatide, experts suggest a delayed treatment. A temporary transition to oral bisphosphonate should be done if the delay goes beyond several months.

For individuals who will not be able to procure continued treatment and are on romosozumab, experts advocate a treatment delay and temporary transition to oral bisphosphonate regimen. Patients on IV bisphosphonates will not be impaired by several months of treatment delays.

It is essential to keep the chronic conditions like osteoporosis on the radar screen since such comorbidities will end up greatly affecting the patient's overall health. Diagnosis of patients who are at risk or those who present with fractures should not be ceased. Thus, clinicians need to be vigilant for those patients who require treatment and administer the available treatments as needed even when full screening tests cannot be performed due to distancing policies.