For more than 2 decades, bisphosphonate drugs have been a first-line therapy for preventing osteoporotic fractures, based on strong clinical evidence showing significant fracture risk reduction within the first 3 to 5 years of treatment. However, data regarding the optimal duration of bisphosphonate treatment to minimize fracture risk beyond this initial period of time are limited.
In September 2015, a Task Force of the American Society Bone and Mineral Research recommended that a drug holiday be considered following 5 years of oral bisphosphonate treatment in women who were not at a high fracture risk, whereas ongoing treatment was felt to benefit women at high fracture risk. In this cohort study of older women who already received 5 years of bisphosphonate therapy, there appeared to be neither hip fracture benefit nor harm associated with discontinuing treatment at study entry or continuing treatment for an additional 5 years. The findings of hip fracture risk are similar to the FLEX randomized clinical trial, in which overall clinical fracture risk was not significantly different between those who took placebo or alendronate for an additional 5 years.
Lots of words, lots of research so what does it mean? Maybe nothing, however, if you are working at decreasing polypharmacy in your center, this may be something to discuss with your medical director. There are risks/benefits to every medication we administer however when residents are receiving multiple medications and the benefits are low, it might be worth reviewing! Stay the course, stay strong, stay well, mask up and stay tuned!