Coronavirus and osteoporosis

Last updated: 16:30 Friday 11 December 2020

Having osteoporosis and taking an osteoporosis drug treatment does not increase your risk of catching coronavirus (COVID-19).

Our free Helpline is still here for you, with our team of specialist nurses now working remotely to take your call.

Your treatment and the COVID vaccine

You can have a COVID vaccine whilst taking any of the osteoporosis medications. The vaccine will be effective and safe for you, and there are no recommendations around having them at different times. It is safe to have them both on the same day.

For further information on COVID vaccines click here

Taking your treatment 

Denosumab and COVID vaccines

You can have a COVID vaccine whilst taking denosumab. The vaccine will be effective and safe for you and there are no recommendations around having them at different times. 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 Prolia® (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.

Your healthcare professional then enrols you in the Prolong patient support programme.

If you're accepted, you can collect your injection from a pharmacy. You can self-administer the injection or, if you have a carer, they can do it for you.

To help you do the injection, you can watch a video tutorial on Prolia.co.uk.

Healthcare professionals are being contacted and asked to enrol people who they feel would benefit from the scheme.

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

Speak to your doctor about whether you can skip your blood test on this occasion. You can refer your doctor to our free Helpline if they're unsure.

Denosumab and Immunity

If you take 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 vaccine.

This is unlike other antibody-based medications used to treat diseases like rheumatoid arthritis.

 

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.

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 Vaccines

You can have a COVID vaccine whilst taking zoledronic acid. The vaccine will be effective and safe for you and there are no recommendations around having them at different times. You can have them both on the same day if this is offered.

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 Vaccines

You can have a COVID vaccine whilst taking Ibandronic acid injections. The vaccine will be effective and safe for you and there are no recommendations around having them at different times. You can have them both on the same day if this is offered.

 

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 vaccines

You can have a COVID vaccine whilst taking teriparatide. The vaccine will be effective and safe for you. You can have your teriparatide injection on the day you have the vaccine – there is no need to miss a dose of teriparatide.

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, self-isolating or social shielding, ask family, friends or a neighbour to help you.

Most areas now have networks and voluntary groups that 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 vaccines

You can have a COVID vaccine whilst taking osteoporosis tablet medications. The vaccine will be effective and safe for you and there are no recommendations around having them on different days. You can have both on the same day.

For further information on osteoporosis treatments - https://theros.org.uk/information-and-support/osteoporosis/treatment/

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.

Read more on managing pain after spinal fractures.

Pre-treatment dental checks during coronavirus

Some of you are 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 are finding that if a pre-treatment dental check-up is needed, this may be delayed.

Most dental practices are beginning to reopen to 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:

  • when they're restarting routine check-ups
  • if they can fit you in as a priority.

With the uncertainty around appointments now, 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 (HCP) 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 on our Freephone number 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 advice on taking vitamin D supplements has changed. It is now advising that during the autumn and winter months everyone should take a daily supplement of 10 micrograms (sometimes called 400 units) of vitamin D.

This new advice is particularly important for people who have been shielding this year due to COVID-19, or who are living in care homes, because they are most likely to have been indoors over the spring and summer and so 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.

Find more information on Vitamin D here or contact our free Helpline.

Appointments

If your hospital appointment is still going ahead, 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 the current situation improves. 

Therapies for pain and wellbeing

Personal therapy clinics and practices, like physiotherapy and occupational therapy, are beginning to start back up. If they do, they'll have strict social distancing measures in place to keep you safe. 

If you usually have therapy to help with pain and wellbeing, try getting in touch with your practice to find out if and when they can start treating you again.

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

Being less active during lockdown 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.

We remain fully committed to offering you the support you need in these challenging times.

Our free Helpline is still here for you, with our team of specialist nurses now working remotely to take your call. And we're looking at new ways that we can give you support while society is social distancing.

If you do get very low and unhappy there are people and organisation that can help you look after your mental wellbeing:

Get support from a Specialist Nurse

Contact our free Helpline for tailored information:

0808 800 0035

Official coronavirus guidance

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