- Long-term alendronate and zoledronic acid reduce fracture risk in women with osteoporosis.
- Benefits of bisphosphonates outweigh harms of rare adverse events such as atypical femoral fractures and osteonecrosis of the jaw, according to a prominent review of the literature.
Why this matters
- An accompanying position paper and editorial recommend new research on who should be considered for drug holidays to reduce harms, when holidays should begin, and how long they should last.
- Systematic review of 9 unique clinical trials and 11 unique observational studies after a search of Medline, EMBASE, and Cochrane library.
- Funding: Agency for Healthcare Research and Quality; NIH.
- In osteoporotic women, 4 years of alendronate (vs placebo) lowers clinical fractures (HR, 0.64; 95% CI, 0.50-0.82) and radiographic vertebral fractures.
- Alendronate has no benefit for women with osteopenia.
- In both osteopenic and osteoporotic women, zoledronic acid (vs placebo) taken long-term lowers clinical fractures (HR, 0.73; 95% CI, 0.60-0.90), including nonvertebral and clinical vertebral fractures.
- For every 1000 women treated with bisphosphonates for 4-6 years, 50-70 will avoid a clinical fracture, whereas 2 will be harmed by subtrochanteric or femoral shaft fracture.
- Raloxifene taken long-term reduces vertebral fractures, but fails to reduce hip fractures and raises risk for venous thromboembolism.
- Denosumab should not be subject to drug holidays.