What osteoporosis treatments can reduce the incidence of COVID-19

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Denosumab, zoledronate and calcium, the main treatments for osteoporosis, have a preventive effect against COVID-19 in patients who take them, according to the results of a collaborative study between Del Mar Hospital, the Del Mar Hospital Medical Institute (IMIM), Pompeu Fabra University and Pere Virgili Health Park. can, in particular, reduce the incidence of infections by 30-40%. The study, the first of its kind in the world, has just been published in the journal Ageing.

The study’s latest author, Dr. Jordi Monfort (head of the Department of Rheumatology at Del Mar Hospital and coordinator of the IMIM Inflammation and Chondrocytes Research Group at Del Mar Hospital), said: “Some drugs used to treat rheumatic diseases may have a positive effect on the natural history of COVID-19. This study analyzed the association between more than 2,000 patients with osteoporosis, osteoarthritis and fibromyalgia and COVID-19 infection.

The starting point was the assumption of Del Mar Hospital specialists that the incidence of pandemic COVID-19 was low in some patients. To analyze this, they collaborated with the research team of the UPF Neuropharmacology Laboratory, the Del Mar Hospital-IMIMIM Integrative Pharmacology and Systems Neuroscience Research Group, and physicians from the Vila Olimpica Primary Care Center (CAP). They studied different treatments and their course in patients with rheumatoid syndrome and non-inflammatory diseases, their association with SARS-CoV-2 infection, their course, need for hospitalization and mortality.

Different mechanisms of activation.
In the case of denosumab, zoledronate, and calcium, the main drugs for the treatment of osteoporosis, data suggest that the incidence of COVID-19 may be significantly reduced in patients taking these drugs. This study suggests that some of these drugs may protect patients from COVID-19 infection, but further studies on larger numbers of patients are needed to confirm this.

In the case of denosumab, it affects not only the RANK/RANKL system, which is involved in skeletal balance, but also the immune system response through activation and differentiation of immune system cells. Its inhibition modulates the inflammatory response and acts on cytokines that play an important role in COVID-19 infection. Zoledronate can also modulate the immune response and stimulate activity against SARS-CoV-2.

The results suggest that another common drug for treating these patients, the antidepressant duloxetine, is also effective in reducing the incidence of COVID-19. Conversely, the commonly used analgesic pregabalin appears to tend to increase the incidence. Based on these findings, Dr. Rafael Maldonado, study author and research team coordinator of the UPF Neuropharmacology Laboratory, recommends: “These anti-osteoporotic drugs are safe and should be continued in patients who take them.” The promising results obtained with duloxetine are important,” and “further studies will be conducted to test the possible favorable effects of duloxetine on COVID-19.”

Similarly, Dr. Alba Grut, a physician at Vila Olimpica CAP Medical Center (Pere Virgili Health Park) and co-author of the study, says, “The data from this study show that the anti-osteoporotic treatment and duloxetine prescribed to our primary care patients are safe against COVID-19 infection and reduce its incidence. It has even been shown to have the potential to do so.” However, more patient studies are needed to confirm this.”

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