What are the AACE recommendations for long-term bisphosphonate therapy for osteoporosis?

Updated: Aug 27, 2020
  • Author: Monique Bethel, MD; Chief Editor: Herbert S Diamond, MD  more...
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In 2016, the American Society for Bone and Mineral Research published guidelines on long-term bisphosphonate treatment that included the following recommendations [144] :

  • After 5 years of oral bisphosphonates or 3 years of intravenous bisphosphonates, reassessment of risk should be considered.
  • In women at high risk (eg, older women, those with a low hip  T-score or high fracture risk score, those with previous major osteoporotic fracture, or those who fracture on therapy), continuation of treatment for up to 10 years (oral) or 6 years (intravenous), with periodic evaluation, should be considered.
  • The risk of atypical femoral fracture, but not osteonecrosis of the jaw, clearly increases with the duration of bisphosphonate therapy, but such rare events are outweighed by vertebral fracture risk reduction in high-risk patients.
  • For women not at high fracture risk, a drug holiday of 2 to 3 years can be considered after 3 to 5 years of bisphosphonate treatment.

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