Vaccination for Coronavirus Disease 2019 (COVID-19) and Relationship to Osteoporosis Care: Current Evidence and Suggested Approaches

Abstract

The development of coronavirus disease 2019 vaccines has proceeded at an unprecedented pace, with numerous trials conducted simultaneously across the world as a result of massive technological and financial resource expenditures. With multiple vaccines having now received regulatory approval, public health efforts to promote widespread vaccine dissemination are currently underway. There has been particular emphasis placed on vaccination of older populations, the age group in which COVID-19 infection has been most lethal. However, such widespread vaccination approaches have necessarily raised important questions related to potential interactions with underlying diseases and concomitant treatments among persons to be vaccinated. Osteoporosis is a chronic condition marked by reduced bone strength and an associated increased risk for fracture that generally requires sustained medical intervention(s). Osteoporosis is neither associated with a higher risk of COVID-19 infection nor by more pronounced disease severity following infection, such that individuals with osteoporosis need not be more highly prioritized for COVID-19 vaccination. Osteoporosis therapies do not interfere with the efficacy or side effect profiles of COVID-19 vaccines and should not be stopped or indefinitely delayed because of vaccination. Depending on the specific drug profile within an anti-osteoporosis medication category, minor adjustments to the timing of drug administration may be considered with respect to the patient's COVID-19 vaccination schedule. Herein we provide practical recommendations for the care of patients requiring treatment for osteoporosis in the setting of COVID-19 vaccination.

COVID-19 and the Endocrine System: A Review of the Current Information and Misinformation

“…Hence, it is recommended their administration be separated from COVID-19 vaccination by a 1-week interval. An interval of 4–7 days is also recommended between the administration of denosumab and romosozumab and COVID-19 vaccination, due to potential injection site reactions, such as localized pain, swelling, and/or erythema [ 83 ].…”

Therapeutic Treatments for Osteoporosis—Which Combination of Pills Is the Best among the Bad?

“…Tsourdi and colleagues addressed this question, and could show that osteoporosis is not associated with a higher risk of COVID-19 infection. Further, it was shown that osteoporosis treatments do not interfere with the efficacy of any COVID-19 vaccination, but possible long-term side effects, although not very likely, such as cross-reactivity of the drugs, have not been evaluated yet [281]. Since the importance of physical activity and exercise to prevent fractures in osteoporotic patients was previously established, it is also important to address the question of how osteoporosis patients might be endangered due to quarantine, staying at home, and movement restrictions [282].…”

The Impact of COVID-19 on the Optimal Management of Osteoporosis

“…For intravenous bisphosphonates, while there is no evidence to suggest the concurrent administration of vaccine and bisphosphonates alters each other’s efficacy, it is empirically recommended to have 4 to 7 days interval between bisphosphonates and vaccine due to the possibility of acute-phase reaction. [ 62 ] Also, if patients who received intravenous bisphosphonates have fever or myalgia over 3 days, evaluation for COVID-19 infection should be considered since the acute phase reaction of bisphosphonates rarely extends over 3 days. [ 63 ] Oral bisphosphonates do not need to be discontinued during vaccination.…”

“…[ 64 ] However, since denosumab can cause injection site dermatitis or eczema,[ 65 ] injections are recommended to be administered at contralateral arms or different sites, or with 4 to 7 days of interval. [ 62 ] Teriparatide and abaloparatide may also induce local injection site reactions but usually do not cause confusion because the injection sites are different from those of vaccines. [ 66 ] Therefore, teriparatide and abaloparatide can be continued during vaccination.…”

“…Therefore, similar to denosumab, injections are recommended to be administered with 4 to 7 days of interval or at alternative sites such as abdomen or thigh. [ 62 ]…”