Are Oral Bisphosphonate 'Drug Holidays' Safe?

Arefa Cassoobhoy, MD, MPH


October 18, 2018

Hello. I'm Dr Arefa Cassoobhoy, a primary care internist, Medscape advisor, and senior medical director for WebMD. Welcome to Medscape Morning Report, our 1-minute news story for primary care.

In the treatment of osteoporosis, it's standard practice to take a course of oral or intravenous (IV) bisphosphonates, followed by a break. This "drug holiday" is considered appropriate in patients with stable bone mineral density, no history of vertebral fractures, and a low risk for future fracture. However, we don't have good evidence about the ideal duration of a drug holiday in terms of fracture risk.

A recent study looked at 160,000 women on Medicare who had taken a bisphosphonate regularly for at least 3 years. Over a median follow-up of 2.7 years, there was a total of 4823 hip fractures. Also, 36% of the women took a drug holiday over a year long.

The absolute difference in fracture rates between the groups was modest, but for those on a bisphosphonate holiday, the risk for hip and humerus fracture was significantly elevated. Stopping risedronate was associated with twice the risk of stopping alendronate, and there wasn't an increased risk with IV zoledronic acid.

The takeaway here is that we have to follow our patients after they finish a course of bisphosphonates. If their risk for fracture increases because of bone mineral density loss, a fracture, or an increase in markers of bone turnover, consider ending the drug holiday and restarting therapy.

Follow Dr Cassoobhoy on Twitter at @ArefaMD


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