Duration of Bisphosphonate Therapy
General Recommendations
- For patients with moderate-to-high fracture risk who have completed 5 years of oral bisphosphonate treatment and are continuing glucocorticoid treatment, the American College of Rheumatology recommends continuation of active osteoporosis treatment 1, 2
- The National Comprehensive Cancer Network recommends reconsidering continuation of bisphosphonate therapy at 2 years for cancer patients with bone metastases 4, 5, 6
Monitoring and Treatment Duration
- During a drug holiday, bone health should be reevaluated every 1-3 years, including serial bone mineral density measurements 3
- Evaluation should also include assessment of bone turnover markers 4
- For multiple myeloma patients, therapy with bisphosphonates should be administered monthly for a period of 2 years 3
Special Considerations
- For postmenopausal women at intermediate or high risk of recurrence, the European Society for Medical Oncology recommends a duration of bisphosphonate treatment of 3-5 years, and only continued after 5 years if indicated by fracture risk 7, 8, 9
- For patients with active cancer or existing bone metastasis, continued bisphosphonate treatment should be considered 4, 5, 6