title: The use of bisphosphonates in women: when to use and when to stop.
abstract: BACKGROUND
  Bisphosphonates (BPs) are the most commonly used drugs in osteoporosis.
  
  
  METHODS
  This review focuses on the criteria for identifying patients who should be treated with BPs and also the rational for the duration of treatment.
  
  
  CONCLUSIONS
  BPs remain the mainstay for the treatment of osteoporosis. For their low cost, the treatment threshold is related exclusively to the ratio between expected benefits and the risk of side effects. This is the case of patients with prior fragility fracture or with low bone density and the presence of other relevant risk factors. The treatment should continue for 3 - 5 years or until fracture risk is no longer high. Afterward a treatment holiday should be considered on the light of the increasing risk of side effects but its duration is still controversial. The duration of this treatment holiday depends on the drug used. Discontinuation of risedronate and ibandronate is associated with the quick loss of the acquired benefits and with these two BPs discontinuation should not exceed 6 months. Alendronate and zoledronate are characterized by a persistent effect after discontinuing treatment and this would allow a more prolonged drug holiday.
authors.affiliation: a University of Verona, Rheumatology Unit , Policlinico Borgo Roma Piazzale Scuro 10, Verona, 37134, Italy +39 04 58 12 40 49 ; +39 04 58 12 68 81 ; maurizio.rossini@univr.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Gatti
authors.affiliation: a University of Verona, Rheumatology Unit , Policlinico Borgo Roma Piazzale Scuro 10, Verona, 37134, Italy +39 04 58 12 40 49 ; +39 04 58 12 68 81 ; maurizio.rossini@univr.it.
authors.forename: Silvano
authors.initials: S
authors.lastname: Adami
authors.affiliation: a University of Verona, Rheumatology Unit , Policlinico Borgo Roma Piazzale Scuro 10, Verona, 37134, Italy +39 04 58 12 40 49 ; +39 04 58 12 68 81 ; maurizio.rossini@univr.it.
authors.forename: Ombretta
authors.initials: O
authors.lastname: Viapiana
authors.affiliation: a University of Verona, Rheumatology Unit , Policlinico Borgo Roma Piazzale Scuro 10, Verona, 37134, Italy +39 04 58 12 40 49 ; +39 04 58 12 68 81 ; maurizio.rossini@univr.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossini
mesh_terms: D019386:Alendronate / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D000077557:Ibandronic Acid; D007093:Imidazoles / Q000627:therapeutic use; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy*; D000068296:Risedronic Acid / Q000627:therapeutic use; D012307:Risk Factors; D013997:Time Factors; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000068296:Risedronic Acid; D000077557:Ibandronic Acid; D019386:Alendronate
keywords: bisphosphonate; drug holiday; osteoporosis; treatment threshold