Bisphosphonates for postmenopausal osteoporosis: Determining duration of treatment
- Piet Geusens
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Doctors who treat patients with osteoporosis are increasingly confronted with the question of how long to continue treatment with bisphosphonates (BPs), which have the unique characteristic of accumulating in the skeleton. Limited available long-term data suggest that such decisions should be made on a case-by-case approach and guided by an individual re-evaluation of clinical fracture risks and bone mineral density, efficacy, and safety issues. In patients who still have a high fracture risk after 5 years of treatment with BPs, continuing treatment could be considered, but stopping BPs could be appropriate in those with a low fracture risk after 5 years of treatment. Switching to recombinant human parathyroid hormone 1–34 or 1–84 is indicated when recurrent incident vertebral fractures occur despite adequate antiresorptive therapy for more than 1 year. However, the usefulness of more than 5 years of treatment with BPs needs to be proved with higher levels of evidence-based medicine.
- Geusens PP: Review of guidelines for testing and treatment of osteoporosis. Curr Osteoporos Rep 2003, 1:59–65. CrossRef
- Geusens PP, Roux CH, Reid DM, et al.: Drug insight: choosing a drug treatment strategy for women with osteoporosis: an evidence-based clinical perspective. Nat Clin Pract Rheumatol 2008, 4:240–248. CrossRef
- Papapoulos S, Compston I: Debate: Excessive suppression of bone remodeling by antiresorptive agents—fact or fiction? 29th Annual Meeting of the American Society for Bone and Mineral Research. Honolulu, HI; September 16–20, 2007.
- Reid IR: Long-term use of alendronate. BoneKEy-Osteovision 2005, 2:10–12.
- Briot K, Trémollières F, Thomas T, et al.: How long should patients take medications for postmenopausal osteoporosis? Joint Bone Spine 2007, 74:24–31. CrossRef
- Kraenzlin ME, Meier C: Does continued alendronate therapy improve bone mineral density and reduce fracture risk in postmenopausal women? Nat Clin Pract Endocrinol Metab 2007, 3:686–687. CrossRef
- Papapoulos SE: Long-term therapy of osteoporosis with bisphosphonates: evidence and implications for daily practice BoneKEy-Osteovision 2005, 2:13–19.
- Rizzoli R: Long-term strategy in the management of postmenopausal osteoporosis. Joint Bone Spine 2007, 74:540–543. CrossRef
- Russell RG, Watts NB, Ebetino FH, Rogers MJ: Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int 2008, 19:733–759. CrossRef
- McClung MR, Wasnich RD, Hosking DJ, et al.: Prevention of postmenopausal bone loss: six-year results from the early postmenopausal intervention cohort study. J Clin Endocrinol Metab 2004, 89:4879–4885. CrossRef
- Wasnich RD, Bagger YZ, Hosking DJ, et al.: Changes in bone density and turnover after alendronate or estrogen withdrawal. Menopause 2004, 11(6 Pt 1):622–630. CrossRef
- Bone HG, Hosking D, Devogelaer J-P, et al.: Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 2004, 350:1189–1199. CrossRef
- 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, 296:2927–2938. CrossRef
- Mellström DD, Sörensen OH, Goemaere S, et al.: Seven years of treatment with risedronate in women with postmenopausal osteoporosis. Calcif Tissue Int 2004, 75:462–468. CrossRef
- Schwartz AV, Bauer DC, Cauley A, et al.: Efficacy of continued alendronate for fractures in women without prevalent vertebral fracture: the FLEX trial [abstract 1057]. Presented at the 29th Annual Meeting of the American Society for Bone and Mineral Research. Honolulu, HI; September 16–20 2007.
- Watts NB, Chines A, Olszynski P, et al.: Fracture risk remains reduced one year after discontinuation of risedronate. Osteoporos Int 2008, 19:365–372. CrossRef
- Allen MR, Burr B: Mineralization, microdamage, and matrix: how bisphosphonates influence material properties of bone. BoneKEy-Osteovision 2007, 4:49–60.
- Chapurlat RD, Arlot M, Burt-Pichat B, et al.: Microcrack frequency and bone remodeling in postmenopausal osteoporotic women on long-term bisphosphonates: a bone biopsy study. J Bone Miner Res 2007 22:1502–1509. CrossRef
- Stepan JJ, Burr DB, Pavo I, et al.: Low bone mineral density is associated with bone microdamage accumulation in postmenopausal women with osteoporosis. Bone 2007, 41:378–385. CrossRef
- McDonald MM, Schindeler A, Little DG: Bisphosphonate treatment and fracture repair. BoneKEy-Osteovision 2007, 4:236–251.
- Lyles KW, Colón-Emeric CS, Magaziner JS, et al.: Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007, 357:1799–1809. CrossRef
- Solomon DH, Hochberg MC, Mogun H, et al.: The relation between bisphosphonate use and non-union of fractures of the humerus in older adults. Osteoporos Int 2008 Oct 9 (Epub ahead of print).
- Mavrokokki T, Cheng A, Stein B, Goss A: Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia. J Oral Maxillofac Surg 2007, 65:415–423. CrossRef
- Shane E, Goldring S, Christakos S, et al.: Osteonecrosis of the jaw: more research needed. J Bone Miner Res 2006, 21:1503–1505. CrossRef
- Khan AA, Sándor GK, Dore E, et al.: Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw. J Rheumatol 2008, 35:1391–1397.
- Salminen S, Pihlajamäki H, Avikainen V, et al.: Specific features associated with femoral shaft fractures caused by low-energy trauma. J Trauma 1997, 43:117–122. CrossRef
- Odvina CV, Zerwekh JE, Rao DS, et al.: Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 2005, 90:1294–1301. CrossRef
- Boonen S, Marin F, Obermayer-Pietsch B, et al.: Effects of previous antiresorptive therapy on the bone mineral density response to two years of teriparatide treatment in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 2008, 93:852–860. CrossRef
- Miller PD, Delmas PD, Lindsay R, et al.: Early responsiveness of women with osteoporosis to teriparatide following therapy with alendronate or risedronate. J Clin Endocrinol Metab 2008, 93:3785–3793. CrossRef
- Laster AJ, Lewiecki EM, ISCD Board of Directors: Vertebral fracture assessment by dual-energy X-ray absorptiometry: insurance coverage issues in the United States. A white paper of the International Society for Clinical Densitometry. J Clin Densitom 2007, 10:227–238. CrossRef
- Kanis JA, Johnell O, Oden A, et al.: FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008, 19:385–397. CrossRef
- Siris ES, Harris ST, Rosen CJ, et al.: Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 2006, 81:1013–1022. CrossRef
- Gallagher AM, Rietbrock S, Olson M, van Staa TP: Fracture outcomes related to persistence and compliance with oral bisphosphonates. J Bone Miner Res 2008, 23:1569–1575. CrossRef
- Bisphosphonates for postmenopausal osteoporosis: Determining duration of treatment
Current Osteoporosis Reports
Volume 7, Issue 1 , pp 12-17
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- Current Science Inc.
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- Piet Geusens (1)
- Author Affiliations
- 1. Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, P. Debyelaan 25, Postbus 5800, 6202 AZ, Maastricht, The Netherlands