Management of drug holidays

Abstract

Bisphosphonates are effective to reduce the risk of osteoporotic fractures, according to prospective randomized trials. However, concerns have been raised recently about safety of long-term administration of these treatments. Based on the potential persistence of effects of these drugs after their discontinuation, it has been suggested that a drug holiday, i.e., a temporary discontinuation of the treatment, could be advisable. There are no evidence-based data to support the management of such drug holidays. Following discontinuation, there is a decrease in BMD and an increase in bone resorption. Patients with a T score higher than −2.5 at the femoral neck after the appropriate duration of treatment may not suffer from a drug holiday. Follow-up of bone markers and BMD is necessary to decide when to resume treatment.