title: Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday.
abstract: The amino-bisphosphonates are first-line therapy for the treatment of most patients with osteoporosis, with proven efficacy to reduce fracture risk at the spine, hip, and other nonvertebral skeletal sites. Further, bisphosphonates have been associated with a significant decrease in morbidity and increase in survival. Following the use of bisphosphonates in millions of patients in clinical practice, some unexpected possible adverse effects have been reported, including osteonecrosis of the jaw, atypical femur fractures, atrial fibrillation, and esophageal cancer. Because bisphosphonates are incorporated into the skeleton and continue to exert an antiresorptive effect for a period of time after dosing is discontinued, the concept of a drug holiday has emerged, whereby the risk of adverse effects might be decreased while the patient still benefits from antifracture efficacy. Patients receiving bisphosphonates who are not at high risk for fracture are potential candidates for a drug holiday, while for those with bone mineral density in the osteoporosis range or previous history of fragility fracture, the benefits of continuing therapy probably far outweigh the risk of harm.
authors.affiliation: Oregon Osteoporosis Center, Portland, OR 97213, USA. mmcclung@orost.com
authors.forename: Michael
authors.initials: M
authors.lastname: McClung
authors.forename: Steven T
authors.initials: ST
authors.lastname: Harris
authors.forename: Paul D
authors.initials: PD
authors.lastname: Miller
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.forename: K Shawn
authors.initials: KS
authors.lastname: Davison
authors.forename: Larry
authors.initials: L
authors.lastname: Dian
authors.forename: David A
authors.initials: DA
authors.lastname: Hanley
authors.forename: David L
authors.initials: DL
authors.lastname: Kendler
authors.forename: Chui Kin
authors.initials: CK
authors.lastname: Yuen
authors.forename: E Michael
authors.initials: EM
authors.lastname: Lewiecki
mesh_terms: D001281:Atrial Fibrillation / Q000139:chemically induced; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000493:pharmacokinetics; D004164:Diphosphonates / Q000009:adverse effects* / Q000493:pharmacokinetics; D004938:Esophageal Neoplasms / Q000139:chemically induced; D005264:Femoral Fractures / Q000139:chemically induced; D050723:Fractures, Bone / Q000517:prevention & control*; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*; D018570:Risk Assessment
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates