Review of impact of drug holidays on bone health

The impact of interruption of anti-osteoporosis treatment in patients on therapy with bisphosphonates or denosumab is reviewed in a new International Osteoporosis Foundation (IOF) working group paper 'Fracture risk following intermission of osteoporosis therapy' published in the journal Osteoporosis International. The widespread practice of recommending one to two year 'drug holidays' arose following concerns that long-term use of bisphosphonates is associated with rare side effects, namely atypical femoral fractures and osteonecrosis of the jaw. However, available evidence suggests that for patients who are at high risk of fracture the risk-benefit ratio is clearly in favour of treatment continuation, with approximately 100 new fragility fractures prevented for each of these adverse events. Lead author, Prof. Elaine Dennison, of the MRC Lifecourse Epidemiology Unit, University of Southampton, UK, stated: "Our aim was to review the available literature to assess what evidence exists to inform decision making on drug holidays and to identify any indicators that might help clinicians decide whether to continue or discontinue therapy in individual patients."