Doctors commonly recommend drug holidays from certain osteoporosis drugs because of the risks associated with these treatments. Yet little has been known about the ideal duration of the holidays and how best to manage patients during this time.
Bisphosphonates for osteoporosis have been shown to cause fractures in the thigh bones and tissue decay in the jawbone. The American Association of Clinical Endocrinologists recommends a drug holiday from these treatments after 4 to 5 years of bone density stability if osteoporosis is moderate and after 10 years of stability if fracture risk is high.
However, new research from Loyola University researchers reveals that patients should resume treatment if they develop a fracture, have a decline in bone strength, or an early rise in signs indicative of increased fracture risk. The researchers also found that elderly patients and those with very low bone strength should be closely followed during a break from treatment. Their findings were published in the November/December 2013 issue of Endocrine Practice.
The researchers conducted a retrospective chart review of 209 patients who started a drug holiday from bisphosphonates between 2005 and 2010. Eleven patients (5.2%) developed fractures and all patients had a significant increase in bone-specific alkaline phosphatase at 6 months. This level was more pronounced in patients who developed a fracture. While there was no significant change in the bone mineral density of the lumbar spine, there was a statistically significant decline in the femoral neck bone mineral density.
“The results highlight groups who are at risk for fractures during drug holidays and recommendations on when to resume treatment,” said Pauline Camacho, MD, lead study investigator and Director of the Loyola University Osteoporosis and Metabolic Bone Disease Center. “These findings will help us continue to refine the current practice of drug holidays to better manage patients with osteoporosis.”
Chiha M, Myers LE, Ball CA, Sinacore JM, Camacno PM. Long-term follow-up of patients on drug holiday from bisphosphonates: real-world setting. Endocr Pract. 2013;19(6):989-994.