What are the recommendations for pharmacologic therapy if osteoporosis is mild or if fracture risk is high?

Updated: Jan 20, 2021
  • Author: Rachel Elizabeth Whitaker Elam, MD, MSc; Chief Editor: Herbert S Diamond, MD  more...
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The AACE recommends that if fracture risk is no longer high or the patient has remained fracture free, clinicians should consider a drug holiday after 5 years of bisphosphonate treatment; treatment should continue up to an additional 5 years if fracture risk remains high. For high fracture risk patients, a drug holiday may be considered after 6-10 years of treatment. For zoledronate, consider a bisphosphonate holiday after 3 years in high-risk patients or until fracture risk is no longer high, and continue for up to 6 years in very-high risk patients. [11]

The ending of a bisphosphonate holiday should be based on individual patient circumstances. BMD and bone turnover markers should be monitored, and treatment should be restarted when the density declines substantially, bone turnover markers increase, or an increase in fracture risk or fracture occurs. [11]

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