Duration of bisphosphonate therapy
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Recently there has been much debate over the optimum duration of bisphosphonate therapy however there is virtually no evidence to base this guideline on. On one hand the risk of over suppression of the bone and atypical fractures related to this e.g. subtrochanteric fractures has been cited. However, this remains an extremely rare occurrence and in virtually every case bisphosphonates prevent many hundreds of fragility fractures relative to the number of atypical fractures attributed to long term bisphosphonate use. There is no evidence for an increase in hip fracture rates with long term bisphosphonate therapy. (Pazianas et al Osteoporos Int (2012) 23:2873-2884). Other justifications for a “drug holiday” from bisphosphonates relate to economic arguments and patient quality of life issues.
Until there is evidence to state that bisphosphonates have continuing anti-fracture efficacy after a course of 5 years the following guidance should be considered and combined with what is practical with the individual patient considering ability to take medication and life expectancy.
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