Bones of contention

Abstract

Patients who are being treated with bisphosphonates for osteoporosis should not stop taking their medications because of fear about rare fractures. Many more fractures of the hip, spine, and other sites are prevented by bisphosphonates than the number of atypical fractures seen. The risk-benefit ratio, therefore, clearly favours treating patients who have osteoporosis with bisphosphonates. It is reasonable to consider drug holidays with careful monitoring for most patients with osteoporosis who are receiving long-term therapy. The evidence of persistent antifracture efficacy after discontinuation must be balanced by the evidence showing that use of alendronate for 10 years is associated with significantly fewer new vertebral fractures and non-vertebral fractures in patients with a bone mineral density T score of 2.5 or less, compared with the use for five years. Decisions about the long-term use of alendronate must be made on an individual basis and discussion with patients about the known risks and benefits of bisphosphonate therapy is recommended. An HMR can facilitate this discussion with the patient and prescriben PN.