Format

Send to:

Choose Destination
See comment in PubMed Commons below
Can Fam Physician. 2014 Apr;60(4):324-33.

Bisphosphonates for treatment of osteoporosis: expected benefits, potential harms, and drug holidays.

Author information

  • 12086 Byron St, Victoria, BC V8R 1L9. ebmedicine@gmail.com.

Abstract

OBJECTIVE:

To outline the efficacy and risks of bisphosphonate therapy for the management of osteoporosis and describe which patients might be eligible for bisphosphonate "drug holiday."

QUALITY OF EVIDENCE:

MEDLINE (PubMed, through December 31, 2012) was used to identify relevant publications for inclusion. Most of the evidence cited is level II evidence (non-randomized, cohort, and other comparisons trials).

MAIN MESSAGE:

The antifracture efficacy of approved first-line bisphosphonates has been proven in randomized controlled clinical trials. However, with more extensive and prolonged clinical use of bisphosphonates, associations have been reported between their administration and the occurrence of rare, but serious, adverse events. Osteonecrosis of the jaw and atypical subtrochanteric and diaphyseal femur fractures might be related to the use of bisphosphonates in osteoporosis, but they are exceedingly rare and they often occur with other comorbidities or concomitant medication use. Drug holidays should only be considered in low-risk patients and in select patients at moderate risk of fracture after 3 to 5 years of therapy.

CONCLUSION:

When bisphosphonates are prescribed to patients at high risk of fracture, their antifracture benefits considerably outweigh their potential for harm. For patients taking bisphosphonates for 3 to 5 years, reassess the need for ongoing therapy.

Comment in

PMID:
24733321
[PubMed - indexed for MEDLINE]
PMCID:
PMC4046542
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Write to the Help Desk