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Coronavirus (COVID-19) and osteoporosis
Last updated: Friday 21 January 2022
Having osteoporosis and taking an osteoporosis medication does not increase your risk of catching coronavirus (COVID-19).
But you may have questions, particularly if you’ve only recently been diagnosed with osteoporosis or started treatment to protect your bones. We’ve answered the most common questions below.
You can also contact our specialist nurses if you still have questions after reading this page.
Your treatment and the COVID vaccine
You can have any of the approved COVID-19 vaccines while having any of the osteoporosis medications. The vaccine will still lower your risk of severe COVID-19 illness and is safe for you to have at any time – including on the same day as your osteoporosis treatment.
There's more information on COVID-19 vaccines on the government website.
Taking your treatment
Denosumab injection
Denosumab and COVID-19 vaccines
You can have a COVID-19 vaccine whilst having denosumab (Prolia®). It's safe and won't affect how well it works. You can have them both on the same day if this is offered.
It’s important that your next injection isn’t delayed for more than four weeks, as the benefits wear off quickly. This causes a sudden drop in bone density and increases your risk of spinal fractures.
You can have repeat injections up to four weeks early, so you have some flexibility.
The NHS is recommending to hospitals and GPs that they make sure you still get your treatment on time.
If you're reluctant to go into hospital for your injection, Amgen, the manufacturer of denosumab, has made resources available to help with self-administration.
A decision on whether you're able to self-administer should be made by your healthcare professional, together with you.
Pre-injection blood tests
We're advising healthcare professionals that not everybody needs to have their pre-injection blood test during the coronavirus pandemic. This is to reduce the risk of exposure to the virus.
If you:
- have had two pre-injection blood tests that have come back normal
- are taking regular calcium or vitamin D supplements
- haven't had any kidney problems since your last injection
then speak to your doctor about whether you can skip your blood test. You can refer your doctor to our free Helpline if they're unsure.
Denosumab and immunity
If you have denosumab, you don’t need to take special measures to protect yourself from infection. You can and should continue to take your medication.
Denosumab is an antibody-based medication, but it doesn't suppress your immune system. This means it doesn't increase your risk of complications from the coronavirus or having a COVID-19 vaccine.
This is unlike other antibody-based medications used to treat diseases like rheumatoid arthritis.
Zoledronic acid infusion
A delay of a few months does not increase your risk of breaking a bone, and won't cause your bone density to significantly drop.
Zoledronic acid is a long-lasting drug. It stays in your body for longer than 12 months, and probably more than 24 months.
If you're prescribed calcium and vitamin D, keep taking them, even if your medication is delayed.
Zoledronic acid and COVID-19 vaccines
You can have a COVID-19 vaccine whilst taking zoledronic acid. It's safe and won't affect how well it works. You can have them both on the same day if this is offered.
Ibandronic acid injection
A delay of a few months does not increase your risk of breaking a bone, and doesn't cause your bone density to significantly drop.
Ibandronic acid is a long-lasting drug.
If you're prescribed calcium and vitamin D, keep taking them, even if your medication is delayed.
Ibandronic acid injections and COVID-19 vaccines
You can have a COVID-19 vaccine whilst having ibandronic acid injections. It's safe and won't affect how well it works. You can have them both on the same day if this is offered.
Teriparatide injections
You should continue your teriparatide injections as normal during the coronavirus pandemic.
If you can't get your prescription, contact your clinical team. Many routine face-to-face appointments are being cancelled, but a telephone appointment may be available instead.
If you miss a few doses, don't worry. This is unlikely to affect your overall bone health. Restart your treatment as soon as you are able.
If you're completing your two-year course, it is important to discuss your treatment plan with your clinical team. Find out more about ending your teriparatide treatment.
Teriparatide and COVID-19 vaccines
You can have a COVID-19 vaccine whilst taking teriparatide. It's safe and won't affect how well it works. You can have them both on the same day if this is offered.
Tablet medication
If you miss a number of doses over a few weeks, your overall bone health is unlikely to be affected.
If you need to collect your prescription, and are unwell or self-isolating, ask family, friends or a neighbour to help you.
Most areas still have networks and voluntary groups that can help people in this situation, so check social media to see if you have any locally that can help you.
If you're prescribed calcium and vitamin D, keep taking them, even if your medication is delayed.
Tablet medications and COVID-19 vaccines
You can have a COVID-19 vaccine whilst taking osteoporosis tablet medications. It's safe and won't affect how well it works. You can have them both on the same day.
Further information on treatments
We have lots of information about osteoporosis treatments.
If you have any questions, our specialist nurses are here for you. Contact our free Helpline by calling 0808 800 0035, or email nurses@theros.org.uk
Dental care during the pandemic
Pre-treatment dental checks during coronavirus
Some of you have been finding pre-treatment check-up appointments with dentists may be delayed. Good dental health may prevent rare drug side effects occurring, which is why these checks are requested before you start some of the drug treatments.
If there is a decision to delay your drug treatment until the dental check occurs, make sure there is a treatment plan and it isn't delayed indefinitely.
Dental checks before starting osteoporosis drug treatments
There is information suggesting a link between some drugs used to treat osteoporosis and a very rare condition called osteonecrosis of the jaw (ONJ). For most people, the benefits of taking a drug treatment far outweigh this rare risk. You can read more about ONJ here.
The condition involves underlying exposure of the jaw bone for longer than expected, associated mainly with dental disease such as infection, or invasive dental procedures such as tooth extraction.
The risk of ONJ related to some treatments taken for osteoporosis is very small but if you are taking a bisphosphonate or denosumab for the treatment of osteoporosis the expert advice, as for the general population, is to maintain good oral hygiene, see your dentist regularly every 6 months and report any problems such as loose teeth, pain or swelling to your dentist.
If you have poor oral hygiene, cancer, chemotherapy or are taking glucocorticoid (“steroid”) tablets your ONJ risk might be slightly increased, so in these circumstances you should probably have your teeth checked before starting an osteoporosis drug treatment. This allows you to get any dental disease treated and to have teeth extractions or implants that are needed before you start the osteoporosis treatment. This will reduce any ONJ risks when you are taking these drugs.
Pre-treatment dental checks during the pandemic
During the pandemic, some people have been finding their pre-treatment dental check-up is delayed.
Most dental practices are offering routine appointments and are taking all necessary coronavirus precautions to keep you safe. You may have to wait a bit longer than you're used to if patients who need urgent care are still being prioritised. But try to see your dentist as soon as you can get an appointment.
Not everyone needs a pre-treatment dental check. But if you do and it’s delayed, ask your dentist:
- if they're offering routine check-ups
- if they can fit you in as a priority.
In practice, your doctor may need to weigh up your need for a drug treatment against what is essentially a very low risk of this very rare condition.
Ask your health care professional if you can start your osteoporosis treatment without a dental check. They may agree to you starting treatment straight away if you are looking after your oral hygiene by following the suggested expert advice explained above.
If your health care professional doesn’t agree to you starting your osteoporosis treatment without a dental check because there is uncertainty about your dental health, make sure that there is a plan to get your delayed medication prescribed once the dental check occurs and that your treatment isn’t delayed indefinitely.
If you want to discuss this further, contact the Specialist Nurse Helpline for free on 0808 800 0035 or email nurses@theros.org.uk
For more information about dentists and coronavirus you can call the Dental Helpline at the Oral Health Foundation for free and impartial advice. 01788 539780 (local rate in the UK)
09:00 to 17:00 Monday to Friday
Find out more about the Dental Helpline https://www.dentalhealth.org/dentalhelpline.
Vitamin D
Public health experts now advise that during the autumn and winter months, everyone should take a daily supplement of 10 micrograms (sometimes called 400 units) of vitamin D.
This is particularly important for people who have been staying indoors during the COVID-19 pandemic, or who are living in care homes, because they may not have been able to obtain enough vitamin D from sunlight.
This is to support general health and in particular bone and muscle health. It is not because vitamin D reduces your risk of coronavirus. There have been some reports about vitamin D reducing the risk of coronavirus (COVID-19). But there is currently not enough evidence to support taking vitamin D to prevent or treat coronavirus.
Read more about vitamin D or contact our free Helpline.
Appointments
If you've been asked to attend a hospital appointment, it means your doctor or specialist is confident the benefits of attending your appointment are greater than your risk of coronavirus.
Be reassured hospitals have special measures in place to keep you safe from coronavirus. You can help by washing your hands, using hand sanitiser at the hospital, and wearing a mask.
If you're feeling unwell on the day of the appointment, it's best not to attend your appointment.
Are you having a virtual or video consultation? Find out more here.
Cancelled appointments
If your routine appointment has been cancelled, try not to worry about your bone health.
Your healthcare professional has decided a delay is unlikely to affect your risk of breaking bones in the long term.
The delay also reduces pressure on the NHS, and keeps you safe from unnecessary exposure to the coronavirus.
It's still important that you get a new appointment when it is safe to do so.
Therapies for pain and wellbeing
Personal therapy clinics and practices, like physiotherapy and occupational therapy, have strict social distancing measures in place to keep you safe.
To help you manage your pain at home, we have lots of information about self-help strategies for pain, and exercise for back pain.
For more support with managing pain, speak with a specialist nurse on our free Helpline.
Coughing with spinal fractures
If you’ve had spinal fractures, we know how painful coughing can be sometimes. But there are some simple things you can do to brace your upper body when you cough, to help make it more comfortable and effective.
In this video, Specialist Helpline Nurse Niki demonstrates some of these techniques, and shares some methods for easing any pain you might have after coughing.
Exercise and physical activity
If you've been less active than usual during the pandemic, this could affect your bone health, because your bones are living tissues that get stronger when you use them. Your muscle strength, coordination and balance can also be affected if you're less mobile and not able to keep up with activities - which could increase your chances of falling and breaking a bone.
So, it’s important you continue to exercise and stay physically active wherever possible.
See our exercise resources for more information about what you can do to promote better bone health and muscle strength, as well as improve your balance.
You're not alone
It’s understandable if you feel anxious. But you're not alone.
The pandemic has been challenging for everyone, but we remain fully committed to offering you the support you need.
Our free Helpline is still here for you, with our team of specialist nurses ready to take your call.
If you do feel very low and unhappy there are people and organisations that can help you look after your mental wellbeing:
