- A bisphosphonate drug holiday of >2 years is associated with an increased rate (20%-35%) of hip, humerus, and clinical vertebral fractures in women age ≥65 years with osteoporosis.
Why this matters
- Findings suggest that the practice of bisphosphonate drug holidays, which is becoming more common, should end.
- Retrospective cohort study using US Medicare fee-for-service women with osteoporosis (n=81,427; 2006-2016) who had been adherent (≥80%) for ≥3 years after newly starting alendronate, risedronate, ibandronate, or zoledronate.
- A drug holiday is no exposure for at least 24 months.
- Funding: NIH.
- 28% of the cohort underwent a drug holiday.
- After a median follow-up of 3.9 years, alendronate discontinuation for >2 years (vs no drug holiday) was tied to a higher risk (adjusted HRs; 95% CIs) for:
- Hip fracture: 1.27 (1.12-1.44);
- Humerus fracture: 1.34 (1.07-1.66); and
- Clinical vertebral fracture: 1.22 (1.10-1.40).
- Distal forearm fracture risk did not change significantly.
- Results were similar for risedronate, ibandronate, and zoledronate for hip and clinical vertebral fractures.
- Observational design.
- Clinical vertebral fracture was not defined.