Using “Drug Holidays” to Avoid Bone Injury

Can taking a “drug holiday” avoid future damage to your bones?

This is the question researchers were asking in their recent study, “Bisphosphonate Drug Holiday and Fracture Risk: A Population‐Based Cohort Study.” This study appears in the March 29, 2018 edition of The Journal of Bone and Mineral Research.

According to the authors, “Our objective was to compare the incidence of osteoporosis‐related fractures among women who had a BP [bisphosphonate] holiday to those who continued to use BPs.”

“This retrospective cohort study, conducted within four Kaiser Permanente integrated health system regions, included 39,502 women aged ≥45 years with ≥3 years exposure to BP. Participants with a BP holiday (≥12 months with no use) were compared to persistent (use with ≥50% adherence) and nonpersistent (use with <50% adherence) users for incident osteoporosis‐related fractures.”

Co-author, Annette Adams, Ph.D., M.P.H., research scientist at the Kaiser Permanente Department of Research & Evaluation, in Pasadena, California, told OTW, “We were interested in this topic because of increasing concerns among our patients and clinicians about adverse events, such as atypical femur fractures (AFF), among long-term users of bisphosphonates.”

“Clinicians were considering bisphosphonate drug holidays as a way of minimizing the risk of AFF, but this strategy makes sense only if the risk of ‘typical’ osteoporosis-related fractures, such as hip and vertebral fractures, does not increase during the drug holiday. We saw our study as a good first step in assessing the utility of bisphosphonate drug holidays for reducing AFF.”

“We observed that women who undertake a bisphosphonate drug holiday after at least three years of continuous bisphosphonate use did not appear to be at any increased risk for major osteoporosis-related fractures, compared to women who remain on the bisphosphonate.”

“At least in our cohort, it appears that a bisphosphonate drug holiday is a viable strategy for balancing the benefits and potential harms associated with long-term bisphosphonate use.”

“While this study represents only one piece of evidence, it appears that bisphosphonate drug holidays do not increase the risk of typical fractures, and thus remain a potential strategy for reducing AFF risk. Consideration of a drug holiday, however, needs to take into account for other patient fracture risk factors and patient preferences regarding treatment. Drug holidays might not be appropriate for all patients, and further work needs to be done to identify those patients for whom drug holidays can be safely considered, or for whom drug holiday should be avoided.”