Bisphosphonate drug holidays: Can we recommend currently?

Area of Science:

• Endocrinology
• Bone Metabolism
• Pharmacology

Background:

• Bisphosphonates (BP) are primary treatments for osteoporosis.
• Long-term BP use is linked to rare subtrochanteric/diaphyseal fractures, prompting debate.
• BP's bone accumulation suggests a persistent protective effect after cessation.

Purpose of the Study:

• To evaluate the concept and evidence for bisphosphonate drug holidays.
• To assess the balance between reducing BP risks and maintaining fracture protection.

Main Methods:

• Review of existing literature and clinical guidelines on bisphosphonate therapy.
• Analysis of data regarding BP accumulation and long-term effects.

Main Results:

• The concept of BP drug holidays is theoretically supported by drug accumulation.
• Current evidence and data supporting drug holidays are insufficient.
• Major osteoporosis guidelines lack specific recommendations for BP drug holidays.

Conclusions:

• Bisphosphonate drug holidays are a potential strategy to mitigate long-term risks.
• More robust research is required to establish evidence-based recommendations for BP drug holidays.
• Current guidelines do not support routine BP drug holidays due to limited data.