Pharmacological management of osteoporosis - when to treat and when to stop

Bisphosphonates are antiresorptive drugs of proven efficacy which are widely used for osteoporosis. After stopping bisphosphonate therapy, residual therapeutic effects persist for an undefined period; thus, some osteoporotic patients could benefit from a temporary discontinuation, the so called 'drug holiday'. Areas covered: We reviewed the effects of discontinuing various anti-fracture treatments in order to clarify both clinical features of patients for whom a drug holiday from an initial bisphosphonate treatment period could be offered and a possible approach to the management of the drug holiday. A PubMed search was undertaken using the following main search terms: 'bisphosphonates', 'drug holiday', 'treatment discontinuation', 'anti-fracture drugs'. Expert commentary: After an initial bisphosphonate treatment period of 3-5 years, fracture risk should be reassessed in order to decide if a drug holiday could be offered to patients. Those at high fracture risk should continue treatment; those at moderate-mild fracture risk could temporarily discontinue treatment.