Background Long-term treatment with bisphosphonates (BP) has been associated with atypical femoral fractures and other complications, so some experts recommend a temporary discontinuation of these drugs in patients with osteoporosis who are receiving them for several years. However, scientific evidence is scarce and scientific societies have not established some detailed recommendations.
Objectives To evaluate the opinion of bone specialists regarding the concept “BP drug holiday” and to ascertain their routine clinical practice.
Methods The ESTRATOS (from Spanish: Treatment Strategy in Osteoporosis) is a 19-item survey regarding the concept “BP drug holiday” and decision-making criteria in clinical practice, addressing members of the Spanish Bone Mineral Metabolism and Research Society (SEIOMM). SPSS v.13.00 software (Chicago, IL) was used for data analysis. Categorical variables were expressed as absolute and relative frequencies; and continuous variables as mean and standard deviation or, as median and range.
Results We collected 146 completed surveys from bone specialists (62% Rheumatologists, and the remaining 58% from Internal Medicine, General Practitioners, Orthopaedic Surgeons and others). About 88% of the participants had good knowledge of the concept “BP drug holiday”, and only 3% stated this should never or exceptionally be considered. More than half (57%) of the participants usually take a time off BP after several years of treatment because of the sustained efficacy of BP after withdrawal, while 40% of them due to the risk of long-term complications, especially atypical femoral fractures. DXA and spine X-ray are the most used tools to make a decision of BP discontinuation, and 1 out of 3 participants believe both are necessary. According to 55% of the participants, BP drug holiday should be considered after 5 to 10 years of treatment, although 35% thought it should be considered after 3-5 years. 99% of the participants have already recommended drug holiday to some of their patients, and 90% consider that it should last 2 or more years, regardless of the type of BP. The main indicators for reintroducing treatment are the occurrence of a new fragility fracture or a significant decrease in BMD.
Conclusions According to our survey bone specialists withdraw temporarily the treatment with BP (drug holiday) in their osteoporotic patients after 3 to 10 years of treatment. Nevertheless, for them it is important to monitor BMD and the incidence of new fragility fractures during the untreated period.
Disclosure of Interest None declared
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