Bisphosphonate therapy for osteoporosis: The long and short of it

Compston, Juliet; Bilezikian, John P.

doi:10.1002/jbmr.1542

Cited by 37 publications

(18 citation statements)

References 18 publications

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“…Currently, women affected by osteoporosis, with a life expectancy of 83.4 yrs, may be treated in western countries (e.g. Italy) with BPs for many years [20], although a considerable controversy regarding the ideal duration of BP therapy exists [9,10,56].…”

Section: Discussionmentioning

confidence: 99%

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Fede

Fusco

Matranga

et al. 2013

European Journal of Internal Medicine

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Section: Discussionmentioning

confidence: 99%

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Fede

Fusco

Matranga

et al. 2013

European Journal of Internal Medicine

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“…The optimal duration of bisphosphonate therapy and the need for possible “drug holidays” is a topic of considerable international controversy. [3–7] The decision to consider “drug holidays” is further complicated by the inconsistency between bone turnover markers and fracture risk. [8, 9] A delicate equipoise surrounding the decision to consider “drug holidays” exists for both patients and physicians.…”

Section: Introductionmentioning

confidence: 99%

Assessing the feasibility of the Effectiveness of Discontinuing Bisphosphonates trial: a pilot study

et al. 2017

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Purpose The comparative effectiveness of continuing or discontinuing long-term alendronate (ALN) on fractures is unknown. A large pragmatic ALN discontinuation study has potential to answer this question. Methods We conducted a 6-month pilot study of the planned The Effectiveness of DiscontinuinG bisphosphonatEs (EDGE) study among current long-term ALN users (women aged ≥65 with ≥3 years of ALN use) to determine study work flow and feasibility including: evaluating the administrative aspects of trial conduct (e.g. time to contract, IRB approval); assessing rates of site and participant recruitment; and evaluating post-randomization outcomes, including adherence, bisphosphonate-associated adverse events, and participant and site satisfaction. We assessed outcomes 1 and 6 months after randomization. Results Nine sites participated, including 7 community-based medical practices, and 2 academic medical centers. On average (SD) contract execution took 3.4 (2.3) months and IRB approval took 13.9 (4.1) days. Sites recruited 27 participants (13 to continue ALN, and 14 to discontinue ALN). Over follow-up, 22% of participants did not adhere to their randomization assignment: 30.8% in the continuation arm and 14.3% in the discontinuation arm. No fractures or adverse events were reported. Sites reported no issues regarding work flow, and participants were highly satisfied with the study. Conclusions Administrative procedures of the EDGE study were generally feasible, with minimal disruption to clinic flow. In this convenience sample, participant recruitment was suboptimal across most practice sites. Accounting for low treatment arm adherence, a comprehensive recruitment approach will be needed to effectively achieve the scientific goals of the EDGE study.

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“…Long-term treatment is associated with fracture reduction but may increase the risk of rare adverse effects such as ONJ and atypical fractures, whereas discontinuation might reduce the risk of ONJ and atypical fractures but may also be associated with reduced protection against fractures. 28) Nevertheless, the strength of evidence for fracture reduction in high-risk patients and the rarity of long-term adverse effects indicate that in the majority of individuals, the benefits of continued treatment outweigh the risks and suggest that treatment should be continued on a long-term basis in individuals who continue to have a high risk of fracture. 28) Mellströmet et al 29) reported that 7 years of continuous risedronate treatment increased BMD, decreased bone turnover to within premenopausal levels, and sustained anti-fracture efficacy in patients with postmenopausal osteoporosis, suggesting the long-term efficacy of risedronate treatment.…”

Section: Discussionmentioning

confidence: 99%

“…28) Nevertheless, the strength of evidence for fracture reduction in high-risk patients and the rarity of long-term adverse effects indicate that in the majority of individuals, the benefits of continued treatment outweigh the risks and suggest that treatment should be continued on a long-term basis in individuals who continue to have a high risk of fracture. 28) Mellströmet et al 29) reported that 7 years of continuous risedronate treatment increased BMD, decreased bone turnover to within premenopausal levels, and sustained anti-fracture efficacy in patients with postmenopausal osteoporosis, suggesting the long-term efficacy of risedronate treatment. In the present study, no serious adverse events, including ONJ or atypical femoral fractures, 16,17) were observed in patients treated with risedronate for 5 years.…”

Section: Discussionmentioning

confidence: 99%

Five-Year Experience with Risedronate Therapy for Patients with Increased Fracture Risk: A Practice-Based Observational Study

Takakuwa¹,

Iwamoto

2015

Biol. Pharm. Bull.

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The purpose of this practice-based observational study was to examine the effects of long-term treatment with risedronate in patients with an increased fracture risk. Seventy patients (4 men and 66 postmenopausal women; mean age, 68.0 years) with osteoporosis or osteopenia and clinical risk factors for fractures were treated with risedronate at either 2.5 mg/d or 17.5 mg/week for 5 years. The bone mineral density (BMD) of the lumbar spine and proximal femur, and the structural geometric parameters of the proximal femur were evaluated by dual-energy X-ray absorptiometry with advanced hip assessment software at baseline and after each year of treatment. The lumbar spine BMD rapidly increased during the first year of the treatment and steadily increased throughout the 5-year treatment period. The BMD of the femoral neck and total hip also significantly increased during the first 3 and 2 years of treatment, respectively, then gradually declined and reached the baseline level after 5 years of treatment. The cross-sectional moment of inertia, cross-sectional area, and mean width of the femoral neck region of interest significantly increased during the first 2 years, and these increases were maintained throughout the 5-year treatment period. The femur strength index and section modulus also significantly increased following time courses similar to those of the above three parameters. These results suggest that risedronate produced both a sustained increase in the lumbar spine BMD and improvement in the femoral structural geometric parameters for 5 years of treatment.Key words risedronate; geometry; bone mineral density; advanced hip assessment; femur strength index Osteoporosis is a skeletal disease characterized by a decrease in bone strength and is associated with an increased fracture risk.1) Bone strength depends on two factors: bone mineral density (BMD) and bone quality. Bone quality is determined by both structural and material factors; structural factors include the macroscopic structure of cancellous bone and the porosity of cortical bone, whereas material factors include the extent of calcification, crystal size, matrix content, and microdamage. 1)Clinical assessment of bone geometry and microstructure has recently become possible because of marked progress in imaging technology. Software for advanced hip assessment (AHA) installed in dual-energy X-ray absorptiometry (DXA) systems is now widely used to noninvasively determine the structural geometric parameters of the proximal femur. 2,3)These structural parameters include the cross-sectional moment of inertia (CSMI) and cross-sectional area (CSA), from which the femur strength index (FSI) can be calculated. The FSI has predictive power for fracture risks in patients along with the BMD, 2,3) and the FSI obtained by DXA with AHA is reportedly well correlated with that obtained by quantitative computed tomography (QCT). 4,5) Risedronate has been widely used as a first-line drug in the treatment of osteoporosis. Current evidence based strictly on the principles ...

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Bisphosphonate therapy for osteoporosis: The long and short of it

Cited by 37 publications

References 18 publications

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Assessing the feasibility of the Effectiveness of Discontinuing Bisphosphonates trial: a pilot study

Five-Year Experience with Risedronate Therapy for Patients with Increased Fracture Risk: A Practice-Based Observational Study

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