Endocrinology in the time of COVID-19: Management of calcium disorders and osteoporosis

Endocrinologists have had to make rapid changes to services so that resources can be focused on the COVID-19 response to help prevent spread of the virus. Herein we provide pragmatic advice on the management of commonly encountered calcium problems and osteoporosis. Non-urgent elective appointments should be postponed, and remote consultations and digital health solutions promoted. Patients should be empowered to self-manage their conditions safely. Patients, their caregivers and healthcare providers should be directed to online resources e.g. Society for Endocrinology, Royal Osteoporosis Society, International Osteoporosis Foundation, specific patient groups and the European Reference Networks (ERNs) for Rare Endocrine and Rare Bone disorders. For patients in acute hospital settings, existing emergency guidance on the management of hyper- and hypo-calcaemia should be followed. A pragmatic, symptom-based approach should be implemented in patients at the end of life. An approach to osteoporosis management is outlined. IV zoledronic acid infusions can be delayed for 6-9 months during the pandemic. Patients established on denosumab and teriparatide should continue planned therapy. The challenge of this pandemic will act as a catalyst to innovate within our management of metabolic bone and mineral disorders to ensure best use of resources and resilience of healthcare systems in its aftermath.