title: Use of bisphosphonates in older adults: how long is long enough?
abstract: OBJECTIVE
  To assess the benefits and risks of long-term bisphosphonates for treatment of osteoporosis in older adults.
  
  
  METHODS
  A MEDLINE search was performed using PubMed from 1966 through 2011 to identify relevant publications. Key words searched included: adverse effects (AEs), aged, alendronate, atrial fibrillation, atypical fractures, bisphosphonate-associated osteonecrosis of the jaw, bisphosphonates, diaphyseal fractures, gastrointestinal cancer, ibandronate, musculoskeletal pain, osteoporosis, risedronate, subtrochanteric fractures, and zoledronic acid. Additional sources were obtained through bibliographic review of selected articles.
  
  
  METHODS
  Relevant studies that examined efficacy and safety of bisphosphonates in the treatment of osteoporosis were included. Focus was given to data involving older adults. Stronger levels of evidence (prospective trials) were given preference as the predominant body of literature, when available.
  
  
  RESULTS
  Osteoporosis affects millions of elderly patients. Bisphosphonates represent first-line therapy. Recent literature has heightened concerns regarding AEs associated with long-term use, leading to the proposition of a "drug holiday." Additionally, there is a lack of literature concerning management of bisphosphonates in older adults.
  
  
  CONCLUSIONS
  Evidence indicates that bisphosphonates maintain their efficacy and safety in older adults. Consideration must be given on a case-by-case basis to potential AEs associated with long-term use, as well as the derived benefit. Drug holidays may be appropriate given consideration of certain patient characteristics. Well-designed, prospective studies are needed to evaluate long-term use and AEs in older adults; therefore, clinical judgment combined with available evidence will have to suffice as the current practice.
authors: Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, Oklahoma 73117, USA. Rebecca-Dunn@ouhsc.edu
authors: Rebecca L
authors: RL
authors: Dunn
authors: Matthew L
authors: ML
authors: Bird
authors: Susan E
authors: SE
authors: Conway
authors: Mark A
authors: MA
authors: Stratton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000139:chemically induced; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D005264:Femoral Fractures / Q000517:prevention & control; D005770:Gastrointestinal Neoplasms / Q000139:chemically induced; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D004164:Diphosphonates