Abstract
The use of standard procedures for the diagnosis of osteoporosis and assessment
of fracture risk significantly decreased during the COVID-19 pandemic, while the
incidence of fragility fractures was mostly unaltered. Both COVID-19 per se and
its treatments are associated with a negative impact on bone health. Preclinical
models show that mice infected with SARS-CoV2 even without symptoms display loss
of trabecular bone mass two weeks post infection, due to increased numbers of
osteoclasts. Osteoporosis medications do not aggravate the clinical course of
COVID-19, while preclinical data suggests possible beneficial effects of some
therapies. While vitamin D deficiency is clearly associated with a worse
clinical course of COVID-19, evidence of improved patient outcome with vitamin D
supplementation is lacking. Osteoporosis treatment should not be generally
discontinued, and recommendations for substituting therapies are available.
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.
Key words
COVID-19 - SARS-CoV2 - bone/calcium homeostasis - osteoporosis - osteopenia - fractures - vitamin D - vaccines