Risks and benefits of long-term bisphosphonate therapy

Schmidt, Ginelle A.; Horner, Kathleen E.; McDanel, Deanna; Ross, Mary B.; Moores, Kevin G.

doi:10.2146/ajhp090506

Cited by 25 publications

(26 citation statements)

References 47 publications

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“…BMD is maintained or increased if the bone had positive response to bisphosphonate [21]. Drug holiday is suggested in the "low risk osteoporotic fracture group" patients with improvement of BMD to normal or osteopenia range, no further fracture history, and good adherence to bisphosphonate for at least 2 years [22,23].…”

Section: Discussionmentioning

confidence: 99%

Atypical Femoral Fractures in a Patient with Continuous Decreasing BMD after Only 1.5 Years of Bisphosphonate Treatment

Hu¹,

Renn²,

Yang³

et al. 2014

OJRA

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Objective: Bisphosphonates were accepted first line treatment for osteoporosis. Long-term bisphosphonate treatment has been reported to be complicated with osteonecrosis of jaw (ONJ) and atypical fracture of femur. It is proposed to be the result of impaired remodeling of minor injury of bone. An atypical fracture occurs on a patient received only 1.5 years of bisphosphonate treatment with continuous decreasing bone mineral density. Case Presentation: This is a 53-year-old female Taiwanese. She has rheumatoid arthritis and has received long-term glucocorticoid treatment. Continuous decrease of bone mineral density in the serial BMD examination after alendronate treatment can be found. Thigh pain occurs after only 1.5 years of bisphosphonate treatment and it progresses to atypical fracture. Conclusions: Atypical fracture can occur in patients receive only shortterm bisphosphonate treatment even BMD is still decreased after bisphosphonate treatment. Autoimmune disease, glucocorticoid treatment, Asian and female may be the possible risk factors.

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Section: Discussionmentioning

confidence: 99%

Atypical Femoral Fractures in a Patient with Continuous Decreasing BMD after Only 1.5 Years of Bisphosphonate Treatment

Hu¹,

Renn²,

Yang³

et al. 2014

OJRA

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“…Drug holidays can be considered for patients who have been treated with bisphosphonate therapy for 5 years who have a stable bone density and no fractures [15]. The beneWts of long-term bisphosphonate therapy outweigh the risks in patients at high risk of fracture [16]. One study assessing the risk and time course of oral bisphosphonate-induced osteonecrosis of the jaws revealed that bone remodeling increased if the oral bisphosphonate was discontinued [17].…”

Section: Discussionmentioning

confidence: 99%

Clinical presentation and pathological features of atypical subtrochanteric fracture after bisphosphonate treatment

Lin

Huang

Hung

et al. 2011

Eur J Orthop Surg Traumatol

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In recent years, there have been increasing reports of fractures associated with long-term bisphosphonate treatment. Clinical presentation should be examined carefully because fractures after long-term bisphosphonate treatment present typical symptoms and radiological and pathological Wndings. The unique clinical features of such fractures include prodromal thigh pain and complete absence of trauma. The radiological features include stress reaction of the thickened cortex and transverse or short oblique fractures on plain-Wlm radiography and bone marrow edema on magnetic resonance imaging. Careful surveillance and early preventive internal surgical Wxation must be considered by both orthopedic and non-orthopedic physicians. In this study, we reviewed recent articles on atypical subtrochanteric fractures after long-term bisphosphonate treatment. We also present the case of a 72-year-old woman with this type of a fracture who had been using a bisphosphonate for 2 years. The Wndings at presentation and pathological features of the fracture are discussed, including those of imaging studies, and the treatment administered is described.

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“…Research suggests that bisphosphonates provide some residual antifracture effect after being stopped and this effect appears to be maintained for 25 years after stopping the drug [Schmidt et al 2010]. More research is necessary to establish the significance of supersuppression of bone turnover by bisphosphonate therapy [Chaiamnuay and Saag, 2006].…”

Section: Bisphosphonates and Renal Impairmentmentioning

confidence: 99%

Safety of drugs used in the treatment of osteoporosis

McGreevy

Williams

2011

Therapeutic Advances in Drug Safety

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A number of drug classes are licensed for the treatment of osteoporosis including bisphosphonates, recombinant human parathyroid hormone (PTH), strontium, hormone replacement therapy (HRT), selective oestrogen receptor modulators (SERMS) and denosumab. This review discusses the safety of osteoporosis treatments and their efficacies. Recent concerns about the safety of calcium and high-dose vitamin D are discussed. Bisphosphonates have substantial postmarketing experience and a clearer picture of safety issues is emerging. Along with the well recognized effects on the gastrointestinal tract and kidney function, recently described adverse effects such as osteonecrosis of the jaw, oesophageal cancer, atrial fibrillation, subtrochanteric femur fractures and ocular complications of bisphosphonate therapy are discussed. Therapy with PTH is limited to two years' duration because of the development of osteogenic sarcomas in animal studies, which appeared related to dose, duration and timing of therapy. Strontium should be used with caution in patients with renal impairment and its use has been associated with venous thromboembolism. The role of HRT and SERMs in the treatment of postmenopausal osteoporosis is restricted as a result of an increased risk of stroke, venous thromboembolism and breast cancer. Postmarketing experience with denusomab is limited but a number of potential safety concerns including osteonecrosis of the jaw are emerging. All of these drugs have been proven to reduce fractures. The decision to use a drug to reduce fracture risk should be based on risk-benefit analysis of the drug and its suitability for individual patients.

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Risks and benefits of long-term bisphosphonate therapy

Cited by 25 publications

References 47 publications

Atypical Femoral Fractures in a Patient with Continuous Decreasing BMD after Only 1.5 Years of Bisphosphonate Treatment

Atypical Femoral Fractures in a Patient with Continuous Decreasing BMD after Only 1.5 Years of Bisphosphonate Treatment

Clinical presentation and pathological features of atypical subtrochanteric fracture after bisphosphonate treatment

Safety of drugs used in the treatment of osteoporosis

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