Following concern about long-term risks of bisphosphonate treatment, some clinicians have considered periodic bone mineral density (BMD) and/or bone turnover marker monitoring during a “drug holiday” after discontinuation of bisphosphonate use. However clinical outcomes data to support this practice are lacking.
The current study investigated this gap in knowledge by using clinical (symptomatic) fracture outcome. Of the 437 study participants, 150 (34.3%) had existing vertebral fractures, suggesting a higher baseline fracture risk than typically seen in a primary care setting. During follow up, 94 women had clinical fractures, 13% of whom had the event less than one year after stopping alendronate therapy.
The author of a related commentary notes that these study results suggest that “identification of patients at high risk of fracture after treatment discontinuation is best accomplished by BMD measurement at the time of discontinuation rather than frequent short-term monitoring with BMD or bone turnover marker measurements after treatment discontinuation. Longer-term research studies are warranted to determine the best clinical practice strategy for management of patients who remain at high fracture risk after discontinuation of 3 to 5 years of bisphosphonate treatment.”