The American Society for Bone and Mineral Research (ASBMR), the American Association of Clinical Endocrinology (AACE), the Endocrine Society, the European Calcified Tissue Society (ECTS), the International Osteoporosis Foundation (IOF), and the National Osteoporosis Foundation (NOF) release joint guidance on COVID-19 vaccination and osteoporosis management. The recommendations are published on the National Osteoporosis Foundation website.
Due to limited available data on the management of patients with osteoporosis receiving vaccination against COVID-19, the current general and medication-specific recommendations are primarily based on expert opinion.
- It is not necessary to prioritize patients with osteoporosis for COVID-19 vaccination, as osteoporosis may not increase the risk for COVID-19 infection or its associated complications.
- During and after receiving the COVID-19 vaccine, patients should continue to maintain general bone health measures (calcium and vitamin D supplementation, weight bearing exercises, and maintenance of a balanced diet) without interruption.
- There is no evidence that osteoporosis therapy increases the severity of COVID-19 infection, alters the disease course, or interferes with efficacy or side effects of COVID-19 vaccination.
Timing of Medication Administration and COVID-19 Vaccination in Patients With Osteoporosis
Standard osteoporosis regimens may be altered to prioritize COVID-19 vaccination.
|Oral bisphosphonates (alendronate, risedronate, and ibandronate)||Continued treatment with oral bisphosphonates, without interruption or delay, in patients receiving vaccination against COVID-19.||Oral bisphosphonates rarely cause acute phase reactions, and there is no evidence that COVID-19 vaccination will lead to bisphosphonate intolerance or that bisphosphonate treatment will reduce the effectiveness of the COVID-19 vaccine.|
|Intravenous (IV) bisphosphonates (zoledronic acid and ibandronate)||One-week interval between IV bisphosphonate infusion and COVID-19 vaccination to distinguish between putative acute phase reactions from the treatment and the vaccine.||There is no evidence that concomitant administration reduces the efficacy or changes the side effect profile of IV bisphosphonates and the COVID-19 vaccine.|
However, clinicians must consider that postinfusion reactions, with a median duration of 3 days after infusion, are a known side effect of IV bisphosphonates; and acute phase reactions are a reported side effect of COVID-19 vaccines. Therefore, it is recommended that administration of IV bisphosphonates and the COVID-19 vaccine be staggered.
|Denosumab||A 4 to 7 day interval between denosumab treatment and COVID-19 vaccination, or denosumab injection in the opposite arm, abdomen, or thigh, if administered concurrently.||There is a potential for injection site reactions with denosumab and the COVID-19 vaccine.|
However, denosumab should not be delayed or discontinued for more than 7 months due to increased vertebral fracture risk, if treatment is delayed or discontinued.
|Teriparatide or abaloparatide||Continued treatment with teriparatide and abaloparatide, without interruption, in patients receiving vaccination against COVID-19.||There is no evidence of increased risk for infection, immunomodulatory effects, or acute phase reactions with teriparatide and abaloparatide. Although both these treatments may induce local injection site reactions, they are not typically administered in the same location as the COVID-19 vaccine (ie, upper arm).|
|Romosozumab||A 4 to 7 day interval between romosozumab and COVID-19 vaccination, or injection of romosozumab in the abdomen (≥2 inches from the navel) or thigh, if administered concurrently.||Upper arm site reactions (pain, swelling, and erythema) are side effects of both romosozumab and the COVID-19 vaccine.|
|Raloxifene||Continued treatment with raloxifene in patients with osteoporosis receiving the COVID-19 vaccines.||There is no known interaction between raloxifene and COVID-19 vaccines.|
National Osteoporosis Foundation. Joint guidance on COVID-19 vaccination and osteoporosis management from the American Society for Bone and Mineral Research (ASBMR), American Association of Clinical Endocrinology (AACE), Endocrine Society, European Calcified Tissue Society (ECTS), the International Osteoporosis Foundation (IOF), and the National Osteoporosis Foundation (NOF). Published online March 9, 2021. Accessed March 25, 2021. https://www.nof.org/news/statement-joint-guidance-on-covid-19-vaccination-and-osteoporosis-management-from-the-asbmr-aace-endocrine-society-ects-iof-and-nof/