How long must I take bisphosphonates for osteoporosis? Are they a lifelong commitment?
Answer From Ann Kearns, M.D., Ph.D.
Bisphosphonates, the most common type of osteoporosis medications, are typically taken for at least 3 to 5 years. After that, your doctor will consider your risk factors in determining whether you should continue to take these or other osteoporosis medications.
Examples of bisphosphonates include:
- Alendronate (Binosto, Fosamax)
- Ibandronate (Boniva)
- Risedronate (Actonel, Atelvia)
- Zoledronic acid (Reclast, Zometa)
These drugs help strengthen bones and prevent fractures. The most common sites for osteoporosis fractures are the wrist, hip and spine. A broken hip can result in a severe decline in quality of life and even increases the risk of death.
Rarely, bisphosphonates may cause:
- Osteonecrosis of the jaw. This bone disease features pain, swelling or infection in the jaw. This occurs most commonly after invasive dental procedures, such as tooth extractions.
- Thighbone fractures. Long-term bisphosphonate therapy has been linked to a rare type of thigh fracture. This injury, known as atypical femoral fracture, is similar to a stress fracture, causing pain that begins subtly and can gradually worsen. If not identified early on, a complete fracture of the thighbone can occur.
To reduce the risk of these rare complications, your doctor may recommend that you temporarily stop taking bisphosphonates after 3 to 5 years. This is sometimes called a bisphosphonate holiday. People who have severe osteoporosis may need to wait for 10 years before they stop taking these drugs.
A bisphosphonate holiday typically lasts at least a year, but it may last indefinitely for some people if the risks of treatment outweigh the benefits. Luckily, the bone-strengthening effects of bisphosphonates appear to continue for several years after people stop taking the drugs.
Ann Kearns, M.D., Ph.D.
July 10, 2021
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See more Expert Answers
- Rosen HN. Bisphosphonate therapy for the treatment of osteoporosis. https://www.uptodate.com/contents/search. Accessed June 9, 2021.
- Osteoporosis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/osteoporosis/osteoporosis?query=osteoporosis. Accessed June 3, 2021.
- Kellerman RD, et al. Osteoporosis. In: Conn's Current Therapy 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed June 3, 2021.
- Ferri FF. Osteoporosis. In: Ferri's Clinical Advisor 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed June 3, 2021.
- Goldman L, et al., eds. Osteoporosis. In: Goldman-Cecil Medicine. 26th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed June 3, 2021.