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The guidance below has been created to assist clinicians in the management of patients with osteoporosis in the era of COVID-19 from The ASBMR, AACE, ENDOCRINE SOCIETY, ECTS & NO. The current pandemic has necessitated the implementation of social distancing strategies that have the potential to disrupt the medical care of patients with osteoporosis.Thus the below recommendations are based primarily on expert opinion

General Recommendations

-The initiation of oral bisphosphonate therapy can be done via telephone or video visit and should not be delayed in patients at high risk for fracture (for example: in patients who have recently sustained an osteoporotic fragility fracture).

-Bone mineral density (BMD) examinations may need to be postponed when public health guidance recommends the halting of elective procedures.

-When possible to do safely, patients who are already taking osteoporosis medications should continue to receive ongoing medications including oral and intravenous (IV) bisphosphonates, denosumab, estrogen, raloxifene, teriparatide, abaloparatide, and romosozumab.

-However, there are early signals that COVID-19 may be accompanied by an increased risk for hypercoagulable complications in which case caution should be used for estrogen and raloxifene, both of which may modestly increase thrombotic risk.

-To facilitate social distancing guidelines and to minimize patient exposure at phlebotomy centers, standard pre-treatment labs (such as calcium, 25-hydroxyvitamin D, and/or creatinine) prior to IV bisphosphonate and/or denosumab administration can be avoided if labs within the preceding year were normal and it is the clinical judgement of the medical provider that a patient’s health has been stable.

-However, laboratory evaluation is recommended for patients with fluctuating renal function and those who are at higher risk of developing hypocalcemia, such as those with malabsorptive disorders, hypoparathyroidism, advanced renal dysfunction (chronic kidney disease stage 4 or 5), or taking loop diuretics.

Specific Recommendations for management of patients who are unable to receive ongoing non-oral osteoporosis medications during the COVID-19 pandemic are provided in the posters attached.

Note: This list is a brief compilation of some of the key recommendations included in the Guideline and is not exhaustive and does not constitute medical advice.

Kindly refer to the original publication here:
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Dr. S●●●●●m S●●●●y P●●●●●l
Dr. S●●●●●m S●●●●y P●●●●●l General Medicine
A very necessary piece of information.
May 23, 2020Like
Dr. S●●●●y M●●●●●●●●i
Dr. S●●●●y M●●●●●●●●i Internal Medicine
Very informative..?
May 27, 2020Like