Update on Rare Adverse Events from Osteoporosis Therapy and Bisphosphonate Drug Holidays

Bisphosphonates remain a first-line treatment for osteoporosis and decrease vertebral and hip fractures without side effects in most patients. With extended treatment, osteonecrosis of the jaw and atypical femoral fracture occur rarely, but fear of side effects has led to not starting or discontinuing treatment. Atrial fibrillation and uveitis are less appreciated by the general public, but their rare incidence must be recognized. A strategy for safe long-term treatment is provided based on 2 major studies. Interruption of treatment after 3 to 5 years is possible for some patients, but those remaining at high fracture risk require longer term therapy.