Bisphosphonates ‘holiday’ gets the clinical nod

Bone health

By Amanda Sheppeard

29 Jan 2016

Patients using bisphosphonates to treat osteoporosis could benefit from a ‘drug holiday’ after three to five years of treatment, new US guidelines recommend.

The new report by a task force of the American Society for Bone and Mineral Research has been welcomed by Professor Peter Ebeling, head of the department of Medicine at the School of Clinical Sciences at Monash Health, and director of the Australian Institute of Musculoskeletal Science (AIMSS).

He said the report, published in this month’s Journal of Bone and Mineral Research , provided solid guidance on the use of oral and intravenous bisphosphonates.

“I think they’re equally relevant to Australia as they are to Americans,” he said.

The guidelines recommend that after five years of oral bisphosphonates or three years of intravenous bisphosphonates, clinicians should reassess the drugs’ potential benefits and risks.

For older women, those with high fracture risks, those with previous major osteoporotic fractures, or who fracture on therapy, continuation of treatment for up to 10 years (oral) or six years (intravenous), with periodic evaluation, should be considered, the guidelines recommend.

For women found to be not at high fracture risk after 3-5 years of treatment, a drug holiday of 2-3 years, with monitoring, can be considered.

“The suggested approach for long-term BP use is based on limited evidence, only for vertebral fracture reduction, in mostly white postmenopausal women, and does not replace the need for clinical judgment,” the report states.

“It may be applicable to men and patients with glucocorticoid-induced osteoporosis, with some adaptations.”

Professor Ebeling said there was no doubt that the benefits of bisphosphonates outweighed the risks, and the effects could be maintained for up to five years.

However he said any ‘drug holiday’ should be approached carefully, so the patient understood that bisphosphonate therapy may need to be recommenced down the track.

“It’s very important it is a holiday – it’s not a retirement,” he told the limbic. “It’s very important that they (patients) get a reminder to return in two to three years for bone density testing.”

One of the main adverse reactions to bisphosphonates is atypical femur fracture, and this affects an estimated 113/100,000 patients who have been using the drug for 6-8 years.

However this compares with the estimated 2600 fractures that are averted per 100,000 patients who have been using bisphosphonates for five years.

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