Osteoporosis: increased fracture rate with long bisphosphonate holiday

  • Curtis JR & al.
  • Med Care
  • 23 Jan 2020

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • Observational design.
  • Clinical vertebral fracture was not defined.