Although provinces and regions are beginning to relax restrictions, COVID-19 continues to delay and disrupt treatment for many patients, including those with osteoporosis.
When it comes to COVID-19 the concern for those with osteoporosis is two-fold—many people are in the high-risk category because of age and underlying conditions, while others may have difficulty accessing drug treatments and medication.
With clinics and doctor offices in various states of operation, this is a challenge further complicated by the fact that the abrupt cessation of some therapies can be associated with an increased risk for harm.
To examine this issue, The American Society for Bone and Mineral Research (ASBMR) set up a steering committee of bone specialists to consider how best to manage these patients and recently published a paper on the evidence behind the recommendations in the Journal of Bone and Mineral Research.
“Because osteoporosis is a chronic disease, continued treatment is a prerequisite in many patients in order to sustain therapeutic benefits, as is the case with other chronic conditions. With the exception of bisphosphonates, which have a long biologic half‐life, other anti‐osteoporosis drugs need to be provided in a regularly scheduled manner. Delaying the administration of certain categories of osteoporosis drugs can have ominous consequences for patients, ranging from loss of bone mass to increases in bone turnover and fracture risk.”
The recommendation is that where possible to do so safely, patients being treated with osteoporosis medications should continue to receive therapies, including oral and iv bisphosphonates, denosumab, estrogen, raloxifene, teriparatide, abaloparatide, and romosozumab.
In a related article published on the Rheumatology Network website, steering committee member Matthew Drake, M.D., of the Division of Endocrinology and Kogod Center on Aging, Mayo Clinic College of Medicine, Rochester, Minnesota, said: “We have no evidence that any of the medications that we use to treat osteoporosis affect COVID-19 in any way, so we don’t think that any of these medications is going to be harmful to someone already infected or will increase their risk of infection. It is mostly a question of how can we avoid any negative repercussions that can come with discontinuation of some of these medications and how can we continue to provide them in the safest possible way.”
Social distancing is important and will continue to be important in the coming months, as communities work to protect the vulnerable and brace for a potential second-wave of COVID-19.
While consultations can be done remotely, via telephone or video link, there needs to be considerations around bone mineral density examinations, lab work and treatments.
“The guidelines make several recommendations as to how medications such as these can be administered while maintaining social distancing. These include: off-site clinics located geographically away from COVID-19 ‘hot-spots’, home delivery with either self-administration or administration by a visiting health professional, and drive-through clinics.”
In addition to ensuring patients can access treatments, now, more than ever, staying fracture-free is critical for those with osteoporosis.
Avoiding visits to the ER is paramount and Osteoporosis Canada offers these highly shareable tips to help avoid hospital and medical visits unless 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 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.