Bisphosphonates are the most commonly used drugs to manage osteoporosis. They reduce fractures at both non-vertebral and vertebral sites by 20 to 70 percent, respectively over a 3 to 10 year period based on results of randomized controlled trials. As a class, bisphosphonates have prolonged skeletal retention and persistent suppression of bone resorption persists, well beyond their period of initial use. Potent IV bisphosphonate may be dosed less often then annually with near similar effects on bone mineral density and fracture risk reduction. Further, concerns have emerged about rare bisphosphonate associated adverse effects including osteonecrosis of the jaw and atypical femoral fractures. Based on the skeletal properties of these drugs and new safety concerns, many clinicians have moved towards a bisphosphonate drug holiday after fixed period of drug use, typically 3 to 5 years. Which patients are optimal candidates for these holidays and when to reinitiate therapy remains controversial. Balancing the potential risk and benefits of these agents is a primary goal improve osteoporosis public health.
Disclosure of Interest None declared