Review of the impact of drug holidays on bone health

The impact of discontinuing anti-osteoporosis treatment in patients on bisphosphonate or denosumab therapy is examined in a new document from the Foundation's Working Group on Osteoporosis (IOF) titled "Risk of fracture after interruption of treatment of osteoporosis "published in the journal International osteoporosis.

The widespread practice of recommending a "holiday-drug" of a year or two has emerged after the long-term use of bisphosphonates is badociated with rare side effects, namely atypical femoral fractures and the Osteonecrosis of the jaw. However, the available evidence suggests that for patients at high risk of fracture, the benefit / risk ratio is clearly in favor of continued treatment, with about 100 new fragility fractures avoided for each of these adverse events.

Professor Elaine Dennison, Epidemiology Unit, MRC Lifecourse, University of Southampton, UK, said, "Our goal was to review the available literature to evaluate the evidence available to inform the decision. decision-making could help clinicians decide whether to continue or stop treatment for each patient. "

In general, few studies have fully considered this topic. However, based on the evidence available in the prospective and retrospective badyzes, the authors found that after discontinuation of bisphosphonate therapy, the risk of new non-vertebral fractures was increased in women whose total hip score was less than -2.5 and the risk of occurrence of clinical lesions. vertebral fractures were about double. In addition, rapid bone loss occurs after stopping denosumab, the incidence of multiple vertebral fractures being about 5%.

Long-term follow-up studies have not shown increased risk of fractures and have reported only very low rates of adverse events on the skeleton, such as atypical fractures. .

Professor Serge Ferrari, co-author and chair of the IOF Scientific Advisory Board, added, "This review underscores the need for a much more nuanced approach to addiction holidays." Osteoporotic fractures can be a danger to death and have a devastating impact on the quality of medications.Physicians and patients should be aware that, especially for high-risk individuals, the benefits of continuing treatment clearly outweigh the risk of drugs. In addition, it is important to understand that bisphosphonates and denosumab are fundamentally different types of treatment that require different approaches, as discontinuation of denosumab results in rapid bone loss, at least in subjects who had not been exposed to long-acting bisphosphonates before. "

Professor Cyrus Cooper, co-author of the FIO, concluded by stating, "The burden of osteoporotic fractures is very high and expensive, leading to disability and loss of autonomy in millions of women and children. Elderly men in the world The effectiveness of proven treatments is well established Instead of practicing a blind application of medical leave, we encourage more informed decision-making and appropriate counseling for the sake of patients. risk on the individual benefits of maintaining treatment in relation to smoking cessation. "