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ASBMR task force gives guidance on long-term bisphosphonate use
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A task force of the American Society of Bone and Mineral Research recently released a report providing guidance on long-term use of bisphosphonates.
Researchers performed three parallel systematic literature searches to identify randomized controlled trials with the terms long-term bisphosphonate use, bisphosphonates and drug holidays, and bisphosphonates and guidelines.
One study showed fewer clinical vertebral fractures among postmenopausal women who received alendronate for 10 years vs. women who switched to placebo after 5 years. A second study showed fewer morphometric vertebral fractures among women who received six annual infusions of zoledronic acid vs. women who switched to placebo after 3 years. Researchers found a beneficial response to continued therapy among the two studies with low hip T-scores. Although the risk of atypical femoral fracture increases with bisphosphonate therapy duration, results showed the events were rare and outweighed by vertebral fracture risk reduction in high-risk patients. Risk of osteonecrosis of the jaw did not increase with bisphosphonate therapy duration, according to results.
Overall, the researchers recommend reassessment of risk should be considered after 5 years of oral bisphosphonate use and 3 years of intravenous bisphosphonates. Older women, women with low hip T-scores or high fracture risk scores, women with previous major osteoporotic fracture or who fracture on therapy should be considered for continuous bisphosphonate treatment for up to 10 years on an oral regimen or for 6 years on an intravenous treatment with periodic evaluation, according to researchers. Results also suggest women not at high fracture risk should be considered for a drug holiday of 2 years to 3 years after 3 years to 5 years of bisphosphonate treatment.
“It is unlikely that there will ever be randomized controlled trials of osteoporosis patients of sufficient size and duration to provide clear evidence that a given strategy over the long term leads to fewer fractures,” Robert A. Adler, MD, a co-author of the study, said in a press release. – by Casey Tingle
Reference:
www.wiley.com/WileyCDA/PressRelease/pressReleaseId-122942.html
Disclosures: Adler receives consulting fees from Amgen and research grants from Genentech, Merck, Novartis, Eli Lilly and Amgen. Please see the full study for a list of all other authors’ relevant financial disclosures.
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