title: Bisphosphonate drug holiday: choosing appropriate candidates.
abstract: Osteoporosis related fractures contribute to morbidity and mortality in U.S. patients, placing a heavy financial burden on society. Randomized clinical trials involving over 30,000 subjects have established bisphosphonates' efficacy in reducing the incidence of fragility fractures. However, as bisphosphonates are retained for years in the skeleton, reports of adverse events from prolonged use are surfacing in the literature, namely, esophageal cancer, atrial fibrillation, osteonecrosis of the jaw, and atypical fracture development. The concept of a drug holiday has been proposed to potentially reduce incidence of these adverse events. This review will highlight the benefits and risks of bisphosphonate therapy and discuss the extension data available from the bisphosphonate trials. As randomized clinical trial evidence is not yet available on who may qualify for drug holiday, this review will provide suggestions for clinicians on identification of possible candidates and monitoring during a bisphosphonate drug holiday.
authors.affiliation: Division of Endocrinology, Diabetes, and Metabolism, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Becker 131, Los Angeles, CA 90048, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Ro
authors.forename: Odelia
authors.initials: O
authors.lastname: Cooper
mesh_terms: D001281:Atrial Fibrillation / Q000139:chemically induced / Q000453:epidemiology; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000453:epidemiology; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use*; D004938:Esophageal Neoplasms / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D018579:Patient Selection; D018570:Risk Assessment
chemical_list: D004164:Diphosphonates