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Controversies in Osteoporosis Management: Concerns About Bisphosphonates and When Are “Drug Holidays” Required?


Clinical Obstetrics and Gynecology: December 2013 - Volume 56 - Issue 4 - p 743–748
doi: 10.1097/GRF.0b013e3182a98295
Controversies in Osteoporosis Management

Bisphosphonates are effective treatments for osteoporosis. The pharmacology and observance of atypical femoral fractures in patients on long-term therapy raise questions about the need for intermittent discontinuation of treatment, a “drug holiday.” Fracture protection benefits of bisphosphonate therapy far outweigh the risk of atypical fractures for the first 10 years of therapy. However, because the fracture probability of therapy abates slowly after stopping the treatment while the risk of atypical fracture appears to decrease quickly, a “drug holiday” of 1 to 2 years should be considered after 3 to 5 years of bisphosphonate therapy except in those patients who remain at very high fracture risk.

Oregon Osteoporosis Center, Portland, Oregon

The author has received consulting fees and honorarium from Amgen, Lilly, Merck, Novartis and Warner-Chilcott and that his center has received research grants from Amgen and Merck.

Correspondence: Michael McClung, MD, Oregon Osteoporosis Center, Portland, OR. E-mail:

© 2013 by Lippincott Williams & Wilkins.