Osteoporosis: how long should we treat?
OBJECTIVE
Bisphosphonates are the most commonly used treatment for osteoporosis. The pharmacology of bisphosphonates suggests the possibility of discontinuing treatment for a period, and patients frequently ask about this. In an attempt to help answer these questions, this review will consider recent data relevant to continuing and discontinuing long-term bisphoshonate therapy and other osteoporosis therapy.


RESULTS
Morphometric vertebral fracture protection continues for 1 year after discontinuation of risedronate for 3 years and there are now similar bishosphonate data for hip fractures. Nonvertebral fractures -in high-risk women - and perhaps clinical vertebral fractures may be reduced in women treated for 10 years with alendronate compared with those who stopped treatment after 5 years. After discontinuing bisphosphonates, bone mineral density appears to deplete more rapidly in the spine than in the hip and biochemical markers appear to increase. These changes occur very rapidly after discontinuing denosumab. Fractures at unusual sites have been reported with long-term bisphosphonate use.


CONCLUSIONS
It appears that a drug holiday can be considered in many patients, although high-risk patients may benefit from continued bisphosphonate therapy. Recent unusual fracture cases need to be considered in making long-term treatment decisions.
Sebba
Anthony
A
University of South Florida, Tampa, Florida 34684, USA. asebba@tampabay.rr.com
D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D002985:Clinical Protocols / Q000592:standards; D000069448:Denosumab; D004164:Diphosphonates / Q000008:administration & dosage*; D006620:Hip Fractures / Q000517:prevention & control; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*; D053245:RANK Ligand / Q000008:administration & dosage; D016103:Spinal Fractures / Q000517:prevention & control; D028761:Withholding Treatment / Q000592:standards / Q000706:statistics & numerical data
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D053245:RANK Ligand; D000069448:Denosumab