More than 15% of osteoporosis patients who take drug holidays suffer bone fractures—most commonly a spinal fracture

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More than 1 in 7 patients taking drug holidays from osteoporosis drugs experience bone fractures

A Loyola Medicine study has found that 15.4% of patients who take drug holidays from osteoporosis drugs called bisphosphonates experienced bone fractures. During a six-year follow-up period, the yearly incidence of fractures ranged from 3.7% to 9.9%, with the most fractures occurring during the fourth and fifth years.

The study, led by senior author Pauline Camacho (Loyola University Osteoporosis and Metabolic Bone Disease Center, Illinois, USA), was published in the journal Endocrine Practice.

Patients who take osteoporosis drugs for long periods are typically advised to temporarily discontinue these drugs to prevent rare but serious side effects to the jaw and thighs.

Sixty-two patients (15.4%) experienced fractures after going on drug holidays. The most common sites were the wrist, foot, ribs and spine. Those most likely to experience fractures were older and had lower bone mineral density at the beginning of the study. Following fractures, patients were put back on bisphosphonates.

Bisphosphonates are the most common medications prescribed for osteoporosis. The drugs slow down the breakdown of bones, helping to maintain bone density and reduce the risk of fractures. However, bisphosphonates have been linked to osteonecrosis of the jaw and atypical femur fracture. Osteonecrosis of the jaw occurs when the jawbone is exposed, typically following a dental procedure, and begins to weaken and die. An atypical femur fracture is an unusual fracture of the thigh bone that can occur even with normal weight bearing.

To reduce the risk of these side effects, the American Association of Clinical Endocrinologists and American College of Endocrinology recommend that women at moderate risk for osteoporosis take a drug holiday after five years of oral and three years of intravenous bisphosphonate treatment. Women at higher risk for osteoporosis should take a drug holiday after 10 years of oral and six years of intravenous bisphosphonate treatment.

However, there is minimal data on how long drug holidays should last. The Loyola study was designed to further characterise the increased fracture risk in patients taking drug holidays. The retrospective study examined the records of 371 women and 30 men with osteoporosis or osteopenia who began drug holidays. The patients had taken bisphosphonates for an average of 6.3 years before beginning drug holidays. The two most frequently prescribed bisphosphonates were alendronate and risedronate.

Drug holidays need further assessment, Camacho and colleagues argue, saying, “Patients who begin drug holidays at high risk for fracture based on bone mineral density, age or other clinical risk factors warrant close follow-up during the holiday.”

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