Dr. Aliya Khan, Dr. Heather Frame, Dr. Claudia Gagnon, Dr. Rowena Ridout, Dr. Lianne Tile and Dr. Sandra Kim

Recommendations from Osteoporosis Canada Rapid Response Team

Osteoporosis is a chronic condition which requires consistent pharmacologic intervention. There is currently no evidence that osteoporosis therapy increases the risk or the severity of COVID-19 infections. With the exception of bisphosphonates, which have long-term skeletal retention, cessation of osteoporosis drug therapy is associated with bone loss and an increased risk of fracture (1, 2). Thus it is important to not stop osteoporosis therapy or delay the dose of medication without consulting your physician.

The COVID -19 vaccine is given intramuscularly and may result in a mild flu like reaction as well as a local injection site reaction. This has been documented with both the adenovirus vector-based vaccine as well as the mRNA-based vaccine (3, 4). Since intravenous zoledronate or injected denosumab or romosozumab medications may also result in a flu like reaction or local injection site reaction, it is advisable that these medications not be administered at the same time as the COVID-19 vaccine. An interval of one week between infusion of the intravenous bisphosphonate zoledronate and COVID-19 vaccination is recommended. An interval of 4-7 days between subcutaneous administration of denosumab or romosozumab and the COVID-19 vaccination is recommended. As teriparatide is administered daily subcutaneously, it can be continued if it is well tolerated and has not resulted in any local injection site reactions. Osteoporosis Canada recommends administration of teriparatide in the abdominal wall or the thigh and not in the same location as the COVID-19 vaccine. Oral bisphosphonates and raloxifene can be continued without any delay in their administration. These recommendations are consistent with the joint recommendations made by the ASMBR, AACE, Endocrine Society, ECTS, IOF and NOF.

Osteoporosis Canada emphasizes the importance of close adherence to the dosing regimens of all osteoporosis medications to ensure optimal skeletal health.

References:

1. Tsourdi E, Zillikens MC, Meier C, et al. Fracture risk and management of discontinuation of denosumab therapy: a systematic review and position statement by ECTS. J Clin Endocrinol Metab. 2020; doi: 10.1210/clinem/dgaa756 [Epub ahead of print)
2. Napoli N, Elderkin AL, Kiel DP, Khosla S. Managing fragility fractures during the COVID-19 pandemic. Nat Rev Endocrinol. 2020;16(9):467-8.
3. Zhu FC, Li YH, Guan XH, et al. Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial. Lancet. 2020;395(10240):1845-54.
4. Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021;384(5):403-16.