For women taking alendronate, a drug holiday of >2 years was linked with a statistically significant 20% rise in hip fractures vs women who never stopped the drug.
“In a large cohort of US women, a bisphosphonate holiday of more than 2 years was associated with a significantly increased risk of hip fracture of up to 39% compared to continued bisphosphonate use,” said Saag. He also noted that the absolute increase in risk was relatively modest, representing an increased fracture rate of 0.5-1 additional fractures during every 100 patient years of follow-up.
In another recent study2, a retrospective chart review of 401 patients with osteopenia or osteoporosis who began a bisphosphonate drug holiday from 2004 to 2013 found 62 (15.4%) patients developed a fracture during follow-up.
Patients 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.
“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, especially as its duration lengthens,” stated the researchers led by senior author Pauline Camacho, MD, Director, Loyola University Osteoporosis and Metabolic Bone Disease Center in Chicago, Illinois. “Fracture risk needs to be regularly assessed during the drug holiday and treatment resumed accordingly.”
1. Saag KG, Curtis JR, Chen R, et al. The impact of the duration of bisphosphonate drug holidays on hip fracture rates. Paper presented at: Annual European Congress of Rheumatology; June 2018; Amsterdam.
2. Bindon B, Adams W, Balasubramanian N, Sandhu J, Camacho P. Osteoporotic fractures during bisphosphonate drug holiday. Endocr Pract. 2018;24:163-169.