Continuing Bisphosphonate Treatment for Osteoporosis — For Whom and for How Long?

Abstract

In the 21st century, osteoporosis, a disease once considered an inevitable consequence of aging, is both diagnosable and treatable. Large, randomized, controlled trials have shown that bisphosphonate therapy for 3 to 4 years is effective in reducing the risk of both nonvertebral and vertebral fractures in osteoporotic women.¹ Not surprisingly, as many as one in seven postmenopausal women in the United States have been treated with a bisphosphonate at some time. However, there is considerable controversy over the ideal duration of antiresorptive therapy, particularly since reports have emerged of atypical subtrochanteric fractures as well as osteonecrosis of the jaw during prolonged bisphosphonate therapy. These concerns prompted the Food and Drug Administration (FDA) to reevaluate the efficacy of continuing bisphosphonate therapy beyond 3 to 5 years, as now described in the Journal article by Whitaker et al. and the agency's briefing document.¹