Duration of Bisphosphonate Therapy

Risk-Based Approach to Bisphosphonate Duration

For adults ≥40 years who have completed 5 years of oral bisphosphonate treatment and continue glucocorticoid treatment with moderate-to-high fracture risk, continued active treatment is recommended, according to the American College of Rheumatology 1, 2, 3
For patients who discontinue glucocorticoid treatment and are assessed to be at low fracture risk, discontinuing bisphosphonate but continuing calcium and vitamin D is recommended, according to the American College of Rheumatology 1, 2
For patients who discontinue glucocorticoid treatment and are assessed to be at moderate-to-high fracture risk, completing the treatment course with the bisphosphonate is recommended, according to the American College of Rheumatology 1, 2

For patients who experience fracture after ≥18 months of oral bisphosphonate therapy or significant bone mineral density decline (≥10%/year), switching to another class of osteoporosis medication or IV bisphosphonate is recommended, according to the American College of Rheumatology 3

For cancer patients with bone metastases, the National Comprehensive Cancer Network recommends reconsidering continuation of bisphosphonate therapy at 2 years 4
For multiple myeloma patients, bisphosphonate therapy should be administered monthly for a period of 2 years, according to Praxis Medical Insights 4
For postmenopausal women at intermediate or high risk of breast cancer recurrence, the European Society for Medical Oncology recommends bisphosphonate treatment for 3-5 years, according to Praxis Medical Insights 4