title: [Therapeutic holidays in osteoporosis: Long-term strategy of treatment with bisphosphonates].
abstract: Oral bisphosphonates (BF) are drugs widely used in the treatment of osteoporosis and placed as first-line treatment for osteoporosis in most clinical guidelines. BF are effective drugs that reduce the incidence of fractures and even reduce mortality. Because of their great affinity for bone, BF have shown that even when they are discontinued still offer a latent protective effect on bone mineral density, maintaining their anti-fracture effect. However, prolonged use for years has been linked to the gradual emergence of complications such as osteonecrosis of the jaw or atypical femur fractures, which have raised questions as when to hold and when to make a final or temporary break, recognized as periods of rest or "therapeutic holidays" of these drugs. Thus, in patients treated with BF for a period of 3-5 years with a low risk of fracture, the drug should be discontinued and restarted when there is an indication for treatment. In contrast, in patients with moderate risk, therapeutic holidays are advised, while reassessing after 2-3 years for restarting purposes. Finally, in patients with high risk of fracture, treatment with BF should not be withdrawn.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, España. Electronic address: mariajesus.moro@salud.madrid.org.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Moro Álvarez
authors.affiliation: Servicio de Ginecología y Obstetricia, Hospital Universitario Cruces, Baracaldo, Vizcaya, España.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Neyro
authors.affiliation: Servicio de Reumatología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, España.
authors.forename: Santos
authors.initials: S
authors.lastname: Castañeda
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000517:prevention & control*; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006801:Humans; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000209:etiology / Q000517:prevention & control*; D028761:Withholding Treatment
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Antiresorptive treatment; Bifosfonatos; Bisphosphonates; Osteoporosis; Therapeutic holidays; Tratamiento antirresortivo; Vacaciones terapéuticas