May 9, 2018

“Drug Holidays” May Lead to Bone Fractures for Patients With Osteoporosis

MAYWOOD, Ill -- May 9, 2018 -- Patients with osteoporosis who take bisphosphonates for long periods typically are advised to temporarily discontinue the drugs to prevent rare but serious side effects. However, a recent study has found that 15.4% of patients who take “drug holidays” experience fractures.

During a 6-year follow-up period, the yearly incidence of fractures ranged from 3.7% to 9.9%, with the most fractures occurring during the fourth and fifth years.

Patients at high risk of fracture who take drug holidays should be closely followed, especially as the drug holiday lengthens, according to Pauline Camacho, MD, Loyola University, Maywood, Illinois, and colleagues.

Bisphosphonates have been linked to osteonecrosis of the jaw (ONJ) and atypical femur fracture. To reduce the risk of these side effects, the American Association of Clinical Endocrinologists and American College of Endocrinology recommend that women at moderate risk for osteoporosis take a drug holiday after 5 years of oral therapy and after 3 years of intravenous treatment. Women at higher risk for osteoporosis should take a drug holiday after 10 years of oral therapy and after 6 years of intravenous treatment. However, there is minimal data on how long drug holidays should last.

The current retrospective study, published in Endocrine Practice, examined the records of 371 women and 30 men with osteoporosis or osteopenia who began drug holidays. The patients had taken bisphosphonates for an average of 6.3 years before beginning drug holidays.

The 2 most frequently prescribed bisphosphonates were alendronate (Fosamax), taken by 62% of patients, and risedronate (Actonel), taken by 34% of patients.

Of the patients, 62 (15.4%) experienced fractures after going on drug holidays. The most common sites were the wrist, foot, ribs, and spine.

Those most likely to experience fractures were older and had lower bone mineral density at the beginning of the study. Following fractures, patients were put back on bisphosphonates.

“Patients who begin drug holidays at high risk for fracture based on bone mineral density, age or other clinical risk factors warrant close follow-up during the holiday, especially as its duration lengthens,” the authors wrote. “Fracture risk needs to be regularly assessed during the drug holiday and treatment resumed accordingly.”

Reference: https://doi.org/10.4158/EP171975.OR

SOURCE: Loyola University Health System
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