Long-term therapy with bisphosphonates: review of clinical studies

Abstract

The purpose of this scientific literature review was to examine clinical recommendations for the duration of bisphosphonate therapy in patients with osteoporosis who have experienced osteoporotic fractures if they remain at high risk after 3–5 years of taking them. An electronic search of electronic databases was conducted, as well as a hand search of journals. A total of 94 publications were examined. 17 publications were included in the review. We concluded that patients who stopped taking bisphosphonates had a 20–40% higher risk of new clinical fractures and nearly twice the risk of vertebral fractures compared with the treatment period, indicating that a drug holiday is recommended not for all patients receiving therapy. However, long-term therapy with alendronate and zoledronic acid has been shown to reduce the risk of fractures in women with osteoporosis. The persistent increase in spinal bone mineral density with long-term bisphosphonate use may explain the lower incidence of vertebral fractures in patients on therapy long-term compared with patients who discontinued therapy after 3 years.