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Organizations responding to “paucity of data” to provide clear guidance for healthcare professionals treating millions of osteoporosis patients


The current COVID-19 global pandemic has necessitated the implementation of social distancing strategies that have the potential to disrupt the medical care of patients with osteoporosis.

In response to this disruption, the American Society for Bone and Mineral Research (ASBMR), American Association of Clinical Endocrinologists (AACE), Endocrine Society, European Calcified Tissue Society (ECTS) and the National Osteoporosis Foundation (NOF) today released guidance to help healthcare professionals treating osteoporosis patients in the era of COVID-19.

The guidelines help address the challenges that social distancing has presented for treating current osteoporosis patients, including those who receive treatment through injection or intravenous (IV) delivery of drugs. It also provides guidance on how some patients may be transitioned to alternative therapies until they are again able to resume their original treatment.

“The scale of the COVID-19 pandemic is unprecedented. There is a paucity of data to provide clear guidance for healthcare professionals on how to adjust treatment for these patients to oral bisphosphonates,” said incoming ASBMR President Suzanne Jan De Beur, M.D., who serves as Associate Professor of Medicine at the Johns Hopkins University School of Medicine. “These recommendations and the supporting evidence provide a roadmap to clinicians and their patients.”

Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds. In the United States, 10.2 million women and men age 50 and above have osteoporosis and 43.4 million Americans over 50 have low bone mass and are at a higher risk of fracture.

With social distancing mandates in place across the nation, many patients are avoiding treatment, and testing and diagnoses are delayed. “We are seeing an 80% decrease in osteoporosis treatment visits at our main MGH hospital,” said Elaine Yu, M.D., MMSc, clinical researcher and endocrinologist at Massachusetts General Hospital (MGH) and Director of the MGH Bone Density Center and Assistant Professor in Medicine at Harvard Medical School.

“We need to ensure that patients are able to safely stay on track with their treatments, and that we continue to do all that we can to reduce their risk for fracture.”

When possible, patients should continue on their prescribed osteoporosis regimens. Specific recommendations for patients who are unable to receive their next dosage of non-oral osteoporosis medications during the COVID-19 pandemic:

  • For patients who are taking denosumab (Prolia®), experts recommend considering a delay in treatment. If the delay exceeds 1 month (i.e. is 7 months from the most recent prior injection), consider temporary transition to oral bisphosphonate.
  • For patients who are taking teriparatide (Forteo®) or abaloparatide (Tymlos®), or romosozumab (Evenity®), experts recommend considering a delay in treatment. If the delay exceeds 3 months, consider temporary transition to oral bisphosphonate.
  • For patients who are on IV bisphosphonates, delays of even several months are unlikely to be harmful.

For the full clinical recommendations, evidence for treatment, and alternative methods for delivering parenteral osteoporosis treatments, visit www.asbmr.org/Statements.aspx.


The American Society for Bone and Mineral Research (ASBMR) is the leading professional, scientific and medical society established to bring together clinical and experimental scientists involved in the study of bone and mineral metabolism. ASBMR encourages and promotes the study of this expanding field through annual scientific meetings, the Journal of Bone and Mineral Research® and JBMR Plus, the Primer on Metabolic Bone Diseases and Disorders of Mineral Metabolism, advocacy and interaction with government agencies and related societies. To learn more about upcoming meetings and publications, please visit  www.asbmr.org.