Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Bisphosphonate Drug Holidays and Fracture Risk

Endocr Pract; 2018 Feb; Bindon, Adams, et al

Patients who begin bisphosphonate (BP) drug holidays—and who are at high risk of fracture based on bone mineral density (BMD), age, or other clinical risk factors—warrant close follow-up, according to a recent study, especially as its duration lengthens. Fracture risk analysis needs to be regularly assessed during the drug holiday and treatment resumed accordingly. A retrospective chart review was conducted of 401 patients with osteopenia or osteoporosis who began a BP drug holiday from 2004 to 2013. Collected parameters included demographics, prior therapy, BMD, bone turnover markers, parathyroid hormone, calcium and vitamin D status, and clinical reports of fractures. Researchers found:

  • 62 (15.4%) patients developed a fracture during follow-up.
  • The yearly incidence of fractures ranged from 3.7 to 9.9%, peaking at 9.9% and 9.8% during years 4 and 5, respectively.
  • The mean age of the fracture group was higher than the nonfracture group, though not significantly different (69.24 ± 12.26 years vs 66.42 ± 10.18 years).
  • Compared to the nonfracture group, the fracture group had lower femoral neck BMD and T-scores at baseline.


Bindon B, Adams W, Balasubramanian N, Sandhu J, Camacho P. Osteoporotic fractures during bisphosphonate drug holiday. Endocr Pract. 2018;24(2):163-169. doi:10.4158/EP171975.OR.

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