As a clinical pharmacist (💊), you’ll hear mixed opinions on how long bisphosphonates (e.g., alendronate) should be used for 🦴 osteoporosis. 🕒 Some patients remain on them indefinitely, but long-term use can pose risks like jaw osteonecrosis (🦷) and atypical femur fractures (🦵).
- Bisphosphonates stay in bones for years, continuing to prevent fractures even after stopping.
- For example, women who stop alendronate after 5 years have the same risk of nonvertebral fractures as those taking it for 10 years.
- Similarly, stopping zoledronic acid (Aclasta) after 3 years is nearly as effective as 6 years.
👩⚕️ Recommendations: Suggest stopping bisphosphonates after 3 to 5 years in most patients. For high-risk patients (recent fractures, chronic steroid use, or ↓ bone density), either continue therapy or switch meds.
- 📊 After stopping, prescribers will likely check bone density or turnover markers in 2-3 years. If bone loss is detected, therapy may restart with bisphosphonates or alternatives like raloxifene, calcitonin, Forteo, or Prolia.
- 💡 Reminders: Encourage 1200 mg/day of calcium and 800-2000 IU/day of vitamin D! 🌞
References
- Whitaker M, Guo J, Kehoe T, Benson G. Bisphosphonates for osteoporosis--where do we go from here? N Engl J Med. 2012 May 31;366(22):2048-51.
- Black DM, Schwartz AV, Ensrud KE, et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006 Dec 27;296(24):2927-38.
