title: Controversies in osteoporosis management: concerns about bisphosphonates and when are "drug holidays" required?
abstract: Bisphosphonates are effective treatments for osteoporosis. The pharmacology and observance of atypical femoral fractures in patients on long-term therapy raise questions about the need for intermittent discontinuation of treatment, a "drug holiday." Fracture protection benefits of bisphosphonate therapy far outweigh the risk of atypical fractures for the first 10 years of therapy. However, because the fracture probability of therapy abates slowly after stopping the treatment while the risk of atypical fracture appears to decrease quickly, a "drug holiday" of 1 to 2 years should be considered after 3 to 5 years of bisphosphonate therapy except in those patients who remain at very high fracture risk.
authors.affiliation: Oregon Osteoporosis Center, Portland, Oregon.
authors.forename: Michael
authors.initials: M
authors.lastname: McClung
mesh_terms: D001281:Atrial Fibrillation / Q000139:chemically induced / Q000517:prevention & control; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000517:prevention & control; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004938:Esophageal Neoplasms / Q000139:chemically induced / Q000517:prevention & control; D005264:Femoral Fractures / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D028761:Withholding Treatment
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates