Bisphosphonate Drug Holidays in Primary Care: When and What to Do Next?
- 2 February 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in Current Osteoporosis Reports
- Vol. 19 (2), 182-188
- https://doi.org/10.1007/s11914-021-00660-4
Abstract
Purpose of Review This 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 Findings Randomized 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. Summary Osteoporosis 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.Keywords
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