Experts question automatic osteoporosis drug holidays
Osteoporosis treatment decisions should be based on individual fracture risk, rather than automatically interrupting or stopping bisphosphonate therapy after five or three years, experts explain in Osteoporosis International.
Bisphosphonates bind to the surface of bone and slow down bone-eroding cells to reduce the risk of hip, vertebral and other fractures. They stay in bone even after people stop taking the medication, so have a persistent, although gradually waning, effect on bone.
The idea of a “bisphosphonate holiday” came about after rare events that have been linked to long-term use of bisphosphonates, including osteonecrosis of the jaw and atypical femoral fracture.
The editorial raises the following key points:
• Some healthcare professionals are automatically stopping bisphosphonates in patients without considering their high risk of fracture;
• Some mistakenly extend the holiday concept to other antiresorptive drugs, where bone density gains are quickly lost when the drugs are discontinued;
• The concept of a need for a drug holiday fuels concerns in people about rare side effects and makes them unnecessarily worried about anti-osteoporosis drugs. Adherence to osteoporosis drug treatment tends to be low so these concerns lead to even lower uptake of medication and greater numbers of high-risk people are left unprotected against fractures.
“There is much clinical confusion about best practice,” says lead author, Prof Stuart Silverman. “We have little global consensus on how to identify which patients should have a drug holiday, and how to manage and monitor these patients. More research is needed so that we can provide physicians with clear recommendations.
“In the meantime we want to remind physicians and patients alike that while the incidence of atypical femoral fracture and osteonecrosis of the jaw are very rare, hip and spinal fractures in high risk patients are, in contrast, far more common and a major cause of disability, loss of quality of life and early death. The benefits of bisphosphonate therapy with regard to reduced fracture incidence in moderate and high risk women clearly outweigh the risk of rare adverse events.”
Instead of automatically starting drug holidays in people who have taken an oral bisphosphonate for five years or an intravenous therapy for three years, the authors assert that healthcare professionals should tailor the decision for each patient based on their fracture risk.
Click here to read the original research.
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