Tuesday, May 4, 2010

Long Term Bisphosphonate Use

This study by Nelson B. Watts and Dima L. Diab from University of Cincinnati is an excellent review of the pharmacodynamics and pharmacokinetics of bisphosphonates and the effect of their long term use. I thought what was striking about this particular article are the recommendations of a drug holiday. This is something many have discussed previously but has not be published significantly.

"Bisphosphonates are popular and effective for treatment of osteoporosis. Because they accumulate in bone and provide some residual antifracture reduction when treatment is stopped, we recommend a drug holiday after 5–10 yr of bisphosphonate treatment. The duration of treatment and length of the holiday are based on fracture risk and pharmacokinetics of the bisphosphonate used. Patients at mild risk might stop treatment after 5 yr and remain off as long as bone mineral density is stable and no fractures occur. Higher risk patients should be treated for 10 yr, have a holiday of no more than a year or two, and perhaps be on a nonbisphosphonate treatment during that time."

Read the full article in Goodreader...

1 comment:

  1. Very nice. I had this on my reading list actually, but didn't read it until new.
    A couple comments:
    1. What to do after 5-10 years of bisphosphonate therapy comes up frequently and often patients are worried about not taking any medication. They are also generally worried about side effects from the other meds. I've often started nasal calcitonin after discontinuing bisphosphonates. It's pretty safe, generally tolerable, and inexpensive. Although it is only mildly effective I have seen improvements in BMD with calcitonin + calcium and D.

    2. There was a brief mention about hip fracture efficacy in forteo. I'm glad to see that here, because I have actively looked to find a study which shows hip fracture reduction with Forteo. I didn't find any and apparently these authors haven't either. For this reason I generally go with fosamax or actonel as first line treatment even for very severe osteoporosis.


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