title: Western Osteoporosis Alliance Clinical Practice Series: Evaluating the Balance of Benefits and Risks of Long-Term Osteoporosis Therapies.
abstract: Osteoporosis is a chronic disease that requires life-long strategies to reduce fracture risk. Few trials have investigated the balance of benefits and risk with long-term use of osteoporosis therapies, and fewer still have investigated the consequences of treatment discontinuation. The best available evidence suggests that up to 10 years of treatment with an oral bisphosphonate maintains the degree of fracture risk reduction observed in the 3-year registration trials. With denosumab, 10 years of therapy appears to provide fracture risk reduction similar to or better than that observed in the 3-year registration trial. Available data suggest an increasing but low risk of fractures with atypical features with increasing duration of bisphosphonate therapy. Published data linking duration of therapy to osteonecrosis of the jaw are lacking for bisphosphonates and denosumab. Other side effects associated with denosumab or bisphosphonates do not appear to be related to therapy duration. The antifracture benefits of long-term therapy with bisphosphonates and denosumab in appropriately selected patients outweigh the low risk of serious side effects.
authors.affiliation: Departments of Medicine, Oncology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada. Electronic address: dahanley@ucalgary.ca.
authors.forename: David A
authors.initials: DA
authors.lastname: Hanley
authors.affiliation: Oregon Osteoporosis Center, Portland; Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia.
authors.forename: Michael R
authors.initials: MR
authors.lastname: McClung
authors.affiliation: A Priori Medical Sciences Inc, Victoria, BC, Canada.
authors.forename: K Shawn
authors.initials: KS
authors.lastname: Davison
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Larry
authors.initials: L
authors.lastname: Dian
authors.affiliation: Department of Medicine, University of California, San Francisco.
authors.forename: Steve T
authors.initials: ST
authors.lastname: Harris
authors.affiliation: Colorado Center for Bone Research, Lakewood.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Miller
authors.affiliation: New Mexico Clinical Research & Osteoporosis Center, Albuquerque.
authors.forename: E Michael
authors.initials: EM
authors.lastname: Lewiecki
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver.
authors.forename: David L
authors.initials: DL
authors.lastname: Kendler
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D000069448:Denosumab / Q000009:adverse effects / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005264:Femoral Fractures / Q000139:chemically induced; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control; D018570:Risk Assessment
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000069448:Denosumab
keywords: Benefits; Bisphosphonate; Denosumab; Fracture; Long-term therapy; Osteoporosis; Risks