A task force of the American Society for Bone and Mineral Research has issued guidance on the bisphosphonate therapy for osteoporosis with a risk-benefit perspective.

The task force was convened in response to growing concerns about prolonged bisphosphonate therapy in osteoporosis patients. The full guidance, “Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research,” can be viewed here.

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After 5 years of oral bisphosphonates or 3 years of intravenous (IV) bisphosphonates, the task force suggests clinicians to reassess the medications’ potential benefits and risks. A continued benefit includes a reduction in the risk of vertebral fractures whereas rare risks include osteonecrosis of the jaw and atypical femoral fracture.

Oral treatment for up to 10 years or IV treatment up to 6 years with periodic evaluation, should be considered for older women with high fracture risks, with previous major osteoporotic fractures, or who fracture on therapy. For women without high fracture risks, a drug holiday of 2–3 years may be considered after 3–5 years of treatment. 

The authors noted that the proposed approach for long-term bisphosphonate use is based on limited evidence (FLEX and HORIZON extension trials), and only for vertebral fracture reduction in mostly white postmenopausal women. They write that the proposed approach, “does not replace the need for clinical judgement.” This guidance may be applicable for men and patients with glucocorticoid-induced osteoporosis with some modifications. 

For more information visit onlinelibrary.wiley.com.