No association of anti-osteoporosis drugs with COVID-19-related outcomes in women: a nationwide cohort study

Abstract

Summary This study was performed to evaluate whether the use of drugs in the treatment of osteoporosis in women is associated with COVID-19 outcomes. The results showed that the risk of hospitalization, intensive care unit admission, and mortality was not altered in individuals taking anti-osteoporosis drugs, suggesting no safety issues during a COVID-19 infection. Introduction Whether patients with COVID-19 receiving anti-osteoporosis drugs have lower risk of worse outcomes has not been reported yet. The aim of this study was to evaluate the association of anti-osteoporosis drug use with COVID-19 outcomes in women. Methods Data obtained from a nationwide, multicenter, retrospective cohort of patients diagnosed with COVID-19 from March 11th to May 30th, 2020 was retrieved from the Turkish Ministry of Health Database. Women 50 years or older with confirmed COVID-19 who were receiving anti-osteoporosis drugs were compared with a 1:1 propensity score-matched COVID-19 positive women who were not receiving these drugs. The primary outcomes were hospitalization, ICU (intensive care unit) admission, and mortality. Results A total of 1997 women on anti-osteoporosis drugs and 1997 control patients were analyzed. In the treatment group, 1787 (89.5%) women were receiving bisphosphonates, 197 (9.9%) denosumab, and 17 (0.9%) teriparatide for the last 12 months. Hospitalization and mortality rates were similar between the treatment and control groups. ICU admission rate was lower in the treatment group (23.0% vs 27.0%, p = 0.013). However, multivariate analysis showed that anti-osteoporosis drug use was not an independent associate of any outcome. Hospitalization, ICU admission, and mortality rates were similar among bisphosphonate, denosumab, or teriparatide users. Conclusion Results of this nationwide study showed that preexisting use of anti-osteoporosis drugs in women did not alter the COVID-19-related risk of hospitalization, ICU admission, and mortality. These results do not suggest discontinuation of these drugs during a COVID-19 infection. Supplementary Information The online version contains supplementary material available at 10.1007/s00198-021-06067-2.

Dispensing anti-osteoporotic drugs changed during the COVID-19 pandemic

“…Women above 50 years old on denosumab did not seem to be in higher risk of COVID-19 infections either [17] . A similar outcome regarding hospitalisation, ICU admission and mortality risk was found for infected women on bisphosphonate, denosumab, or teriparatide therapy and those without treatment [18] . The authors suggest that anti-osteoporotic drugs should therefore not be discontinued during COVID-19 infection [18] .…”

“…A similar outcome regarding hospitalisation, ICU admission and mortality risk was found for infected women on bisphosphonate, denosumab, or teriparatide therapy and those without treatment [18] . The authors suggest that anti-osteoporotic drugs should therefore not be discontinued during COVID-19 infection [18] . This suggestion is in line with the more recent data showing that oral bisphosphonates and vitamin D were not associated with an increased risk for COVID-19 infections [19] .…”

Outcome of COVID19 in Patients With Osteogenesis Imperfecta: A Retrospective Multicenter Study in Saudi Arabia

“…Based on animal studies, bisphosphonate was found to have antiinflammatory and immune-modulating effects, which may improve the outcome of SARS-CoV-2 pneumonia (24). Several observational retrospective case-controlled studies showed conflicting results regarding the impact of bisphosphonate on the development of adult patients hospitalized with COVID-19 pneumonia (25)(26)(27). One retrospective study showed that patients on parenteral zoledronate had a low incidence of COVID-19 after adjustment for different confounding factors such as age and comorbidities (25).…”

“…One retrospective study showed that patients on parenteral zoledronate had a low incidence of COVID-19 after adjustment for different confounding factors such as age and comorbidities (25). While another two retrospective studies did not show that prior use of bisphosphonate did improve the outcome and progression to severe disease in COVID-19 adult patients (26,27). It is worth emphasizing that these studies evaluated the prior use of bisphosphonate and its effect on COVID-19 disease severity without describing the degree of BMD and the presence of fractures.…”

The Impact of COVID-19 in Bone Metabolism: Basic and Clinical Aspects

“…The vast majority of the 1997 women with osteoporosis received bisphosphonates. This study reported that hospitalization risk, ICU admissions and mortality rates were not influenced by bisphosphonates or any other drug category [86]. In contrast, a separate study showed that treatment with zoledronate was associated with a 40% decreased risk of COVID-19 infection, whereas oral bisphosphonates had no effect on COVID-19 incidence [34].…”