TITLE:
How Long to Treat with Bisphosphonates?
AUTHORS:
Fahad M. Alshahrani, Mussa H. Almalki
KEYWORDS:
Osteoporosis, Bisphosphonate, Drug Holiday, Fragility Fracture, Bone Mineral Density, Bone Turnover Markers
JOURNAL NAME:
Health,
Vol.7 No.12,
December
9,
2015
ABSTRACT: Bisphosphonate class of drugs, the most commonly prescribed for the treatment of osteoporosis, is effective in preventing and treating bone loss and fractures. However, the treatment duration and the applicability of “drug holidays” for bisphosphonates need optimization in order to minimize long-term exposure. Drug holidays may prevent potential adverse events while still maintaining some degree of antifracture efficacy via residual antiresorptive activity by retained bisphosphonates. Patients receiving bisphosphonates, who are at low-moderate risk of fracture, are potential candidates for a drug holiday. However, for high-risk patients or patients with previous history of fragility fractures, the benefits of continuing bisphosphonate therapy considerably out-weigh their potential harm. Evidence-based guidelines regarding starting and stopping a drug holiday are not available; therefore, it is appropriate to monitor patients on a drug holiday to assess a declining antiresorptive effect. In case of a significant rise in bone turnover markers or significant decrease in bone mineral density, it may be time to restart therapy.