Bisphosphonate holiday for some after 4 to 5 years

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Bisphosphonate holiday for some after 4 to 5 years

Patients on long-term alendronate/risedronate should be reassessed after 4 to 5 years:

  • If their  P1NP (bone turnover marker) is < 35 mcg/l and their femoral T-score is better than -2.5 and there are no new fractures,  they can have a drug holiday (oral medication only)  for 4 to 5 years.

  • If T-score is worse than -2.5 or new fracture then continue treatment for 4-5 more years of oral medication and reassess (consider a 1-2 year drug holiday in this period).

  • After 5 to 10 years of oral treatment, consider a 1-2 year holiday.

    IV zoledronate is an alternative option, given every 18 to 24 months for 3-4 doses, then every 3 years if T-score remains worse than -2.5. In those on oral bisphosphonate with PINP > 35 μg/L, a change to IV is often indicated.

    Bisphosphonates prevent fractures without the need for calcium supplements, though vitamin D should be provided to those at risk of deficiency (frail elderly, institutionalised etc).1

    This Gem has been checked by Professor Ian Reid, University of Auckland.


    1. Guidance on the Diagnosis and Management of Osteoporosis in New Zealand. Osteoporosis NZ (2017)  Click here 

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

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As published in NZ Doctor 24/10/2018