Bisphosphonate Drug Holidays in Primary Care: When and What to Do Next?

AbstractPurpose of ReviewThis review describes the rational for bisphosphonate holidays, summaries key evidence to support the concept, and provides a roadmap to help clinicians initiate, monitor, and discontinue a bisphosphonate drug holiday.Recent FindingsRandomized trials and data from large observational studies are available to determine the short and long-term bisphosphonate benefits (prevention of fracture) and harms (principally atypical femoral fractures and osteonecrosis of the jaw). Mounting evidence points towards a causal relationship between bisphosphonate use and AFF and ONJ, particularly with>  5 years of use. Multiple studies now confirm the risk of AFF falls rapidly after BPs are discontinued.SummaryOsteoporosis patients without previous hip, vertebral, or multiple non-spine fractures who are successfully treated with oral bisphosphonates for 5  years (3 years if intravenous), should be offered a 3–5 year drug holiday, particularly if hip BMD T-score is>  − 2.5. Bisphosphonates should only be continued beyond 10 years (6 years if parenteral) in patients at very high risk of fracture.
Source: Current Osteoporosis Reports - Category: Orthopaedics Source Type: research