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Longer Bisphosphonate Drug Holiday May Up Fracture Risk

For those with previous vertebral fracture, major osteoporotic fractures increased with holidays >12 months

FRIDAY, Aug. 7, 2020 (HealthDay News) -- In patients who have previously suffered a vertebral fracture, a longer bisphosphonate (BP) drug holiday is associated with an increased risk for major osteoporotic fractures (MOFs), according to a study published online in the September issue of Bone.

Johannes Pfeilschifter, M.D., from Ruhr University Bochum in Germany, and colleagues examined osteoporotic fractures and mortality in 1,973 patients treated with BP for at least 80 percent of the time during the preceding four years. Differences in fracture risk were also evaluated during BP holidays.

The researchers found that at the time of the first interview, the adjusted hazard ratios (HRs) for BP holidays compared with ongoing BP use were 0.87 for MOFs (95 percent confidence interval [CI], 0.59 to 1.28), 0.95 for any clinical osteoporotic fracture (95 percent CI, 0.70 to 1.28), 0.96 for clinical vertebral fractures (95 percent CI, 0.55 to 1.68), and 0.86 for mortality (95 percent CI, 0.50 to 1.48). Compared with a BP simple moving average (SMA) level of greater than 0 percent to less than 50 percent (corresponding to a time more than six months to 12 months or less since the start of a BP holiday), the risk for MOFs was higher for the BP-SMA level 0 percent (corresponding to more than 12 months since the start of a BP holiday; adjusted HR, 2.28; 95 percent CI, 1.07 to 4.86). For MOFs for the BP-SMA level 0 percent, the adjusted HR was 3.53 (95 percent CI, 1.19 to 10.51) versus the BP-SMA level greater than 0 percent to less than 50 percent with a prevalent vertebral fracture but was 1.44 (95 percent CI, 0.49 to 4.22) without a prevalent vertebral fracture.

"The decision regarding further management of osteoporosis in patients on bisphosphonate therapy should be made individually for each patient based on the benefits and potential risks of the available treatment options, and should be re-evaluated on a periodic basis," Pfeilschifter said in a statement.

Several authors disclosed financial ties to medical and pharmaceutical companies.

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