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To
aid healthcare professionals treating osteoporosis patients during COVID-19,
five prominent bone health organizations released joint guidance yielding
recommendations for patients whose plan of osteoporosis treatment is either
continuing or has been disrupted.
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.
Medscape
Don't Neglect Osteoporosis Therapy During COVID-19, Say Societies
Steve Cimino
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