title: Bisphosphonates for treatment of osteoporosis: expected benefits, potential harms, and drug holidays.
abstract: OBJECTIVE
  To outline the efficacy and risks of bisphosphonate therapy for the management of osteoporosis and describe which patients might be eligible for bisphosphonate "drug holiday."
  
  
  METHODS
  MEDLINE (PubMed, through December 31, 2012) was used to identify relevant publications for inclusion. Most of the evidence cited is level II evidence (non-randomized, cohort, and other comparisons trials).
  
  
  RESULTS
  The antifracture efficacy of approved first-line bisphosphonates has been proven in randomized controlled clinical trials. However, with more extensive and prolonged clinical use of bisphosphonates, associations have been reported between their administration and the occurrence of rare, but serious, adverse events. Osteonecrosis of the jaw and atypical subtrochanteric and diaphyseal femur fractures might be related to the use of bisphosphonates in osteoporosis, but they are exceedingly rare and they often occur with other comorbidities or concomitant medication use. Drug holidays should only be considered in low-risk patients and in select patients at moderate risk of fracture after 3 to 5 years of therapy.
  
  
  CONCLUSIONS
  When bisphosphonates are prescribed to patients at high risk of fracture, their antifracture benefits considerably outweigh their potential for harm. For patients taking bisphosphonates for 3 to 5 years, reassess the need for ongoing therapy.
authors.affiliation: 2086 Byron St, Victoria, BC V8R 1L9. ebmedicine@gmail.com.
authors.forename: Jacques P
authors.initials: JP
authors.lastname: Brown
authors.forename: Suzanne
authors.initials: S
authors.lastname: Morin
authors.forename: William
authors.initials: W
authors.lastname: Leslie
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
authors.forename: Angela M
authors.initials: AM
authors.lastname: Cheung
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Davison
authors.forename: David
authors.initials: D
authors.lastname: Goltzman
authors.forename: David Arthur
authors.initials: DA
authors.lastname: Hanley
authors.forename: Anthony
authors.initials: A
authors.lastname: Hodsman
authors.forename: Robert
authors.initials: R
authors.lastname: Josse
authors.forename: Algis
authors.initials: A
authors.lastname: Jovaisas
authors.forename: Angela
authors.initials: A
authors.lastname: Juby
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kaiser
authors.forename: Andrew
authors.initials: A
authors.lastname: Karaplis
authors.forename: David
authors.initials: D
authors.lastname: Kendler
authors.forename: Aliya
authors.initials: A
authors.lastname: Khan
authors.forename: Daniel
authors.initials: D
authors.lastname: Ngui
authors.forename: Wojciech
authors.initials: W
authors.lastname: Olszynski
authors.forename: Louis-Georges
authors.initials: LG
authors.lastname: Ste-Marie
authors.forename: Jonathan
authors.initials: J
authors.lastname: Adachi
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; D018483:Diaphyses / Q000293:injuries; D004164:Diphosphonates / Q000009:adverse effects* / Q000493:pharmacokinetics; D004938:Esophageal Neoplasms / Q000139:chemically induced; D005264:Femoral Fractures / Q000139:chemically induced; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D051437:Renal Insufficiency / Q000150:complications; D018570:Risk Assessment
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
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