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.

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July 10, 2021 See more Expert Answers