NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Osteoporosis: Denosumab continuation COVID

Key point

  • Denosumab treatment for osteoporosis should continue during the current COVID-19 pandemic.

Please refer to the following statement from the NHSGGC Osteoporosis Strategy Group:

  • A frequent question that has come up in the context of the current COVID-19 pandemic relates to what to do regarding patients with osteoporosis on treatment with denosumab.
  • There is already some guidance around this from the Royal Osteoporosis Society (see www.theROS.org.uk) including information for patients and useful advice on when a pre-treatment blood sample might not be needed.
  • Although denosumab is a monoclonal antibody, this treatment is not associated with immunosuppression. It is important that this treatment is continued.
  • If treatment is delayed by more than 4 weeks there may be a rapid offset in effect. This offset is associated with a temporary increase in bone turnover which in turn may be associated with an increase in vertebral fracture risk.
  • Denosumab can be used continuously for up to 10 years. The NHSGGC Shared Care Agreement here suggests a reassessment might take place after 3 years of therapy. This 3 year window is however somewhat arbitrary. For patients coming up to 3 years of therapy now or within the next few months, denosumab therapy should be continued and referral to secondary care Bone Metabolism Services delayed until routine outpatient services re-open later in the year.
  • Should there be situations where clinical circumstances dictate that denosumab therapy needs to be stopped within the time that routine outpatient services are suspended, then individual cases should be discussed one-to-one between GP and the relevant local consultant team.


First published 31/03/2020. Updated 27/04/20. Medicines Update blogs are correct at the time of publication.