(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 Bone.

Johannes Pfeilschifter, MD, from Ruhr University Bochum in Germany, and colleagues examined osteoporotic fractures and mortality in 1973 patients treated with BP for at least 80% of the time during the preceding 4 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% confidence interval [CI], 0.59 to 1.28), 0.95 for any clinical osteoporotic fracture (95% CI, 0.70 to 1.28), 0.96 for clinical vertebral fractures (95% CI, 0.55 to 1.68), and 0.86 for mortality (95% CI, 0.50 to 1.48). Compared with a BP simple moving average (SMA) level of greater than 0% to less than 50% (corresponding to a time more than 6 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% (corresponding to more than 12 months since the start of a BP holiday; adjusted HR, 2.28; 95% CI, 1.07 to 4.86). For MOFs for the BP-SMA level 0%, the adjusted HR was 3.53 (95% CI, 1.19 to 10.51) versus the BP-SMA level greater than 0% to less than 50% with a prevalent vertebral fracture but was 1.44 (95% CI, 0.49 to 4.22) without a prevalent vertebral fracture.

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“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.


Pfeilschifter J, Steinebach I, Trampisch HJ, et al. Bisphosphonate drug holidays: Risk of fractures and mortality in a prospective cohort study. Bone.