In women with prior bisphosphonate treatment, who should have lower risk for subsequent fracture than those without prior treatment, the balance of benefits to harms for continued treatment versus discontinuation is less clear. It seems less favourable than the balance supporting initial treatment, in treatment-naive patients because evidence suggests that continuation does not reduce nonvertebral fractures and only inconsistently reduces vertebral fractures.
A related editorial together with the US National Institute for Health report, discuss the gaps in research and knowledge, highlighting important questions to consider when considering how long treatment should be maintained, how treatment should be monitored, in what order treatments should be used, and whether drug holidays should be considered or implemented.