Discontinuation of Alendronate Therapy

Duration of Treatment Recommendations

The American College of Physicians recommends treating osteoporotic women with pharmacologic therapy for 5 years, after which the benefits of continued therapy should be reassessed 1
For patients with very high fracture risk, continuing alendronate beyond 5 years may be beneficial, as supported by guidelines from the National Comprehensive Cancer Network 2, 3
After discontinuing alendronate following 5 years of treatment, there is a modest absolute increase in clinical vertebral fractures, but no significant difference in morphometric vertebral fractures or non-vertebral fractures 2

Before stopping alendronate, perform a comprehensive fracture risk reassessment, including BMD measurement with vertebral fracture assessment or spinal x-ray, and updated FRAX score, as recommended by the Arthritis and Rheumatology society 4, 5
Factors favoring continuation beyond 5 years include very high fracture risk, ongoing high-dose glucocorticoid therapy, and significant bone loss during treatment, according to the Arthritis and Rheumatology society 4, 5

BMD with VFA or spinal x-ray should be performed every 1-2 years after osteoporosis therapy is discontinued, as recommended by the Arthritis and Rheumatology society 4, 5
Current evidence does not support bone density monitoring during the 5-year pharmacologic treatment period, according to the American College of Physicians 1

Prolonged bisphosphonate use raises concerns about potential adverse effects of chronic suppression of bone turnover, as noted by the Clinical Infectious Diseases journal 6
Rare but serious adverse events associated with long-term bisphosphonate use include risks that increase with duration of exposure, according to the Clinical Infectious Diseases journal 7, 6

For patients with continued risk factors for bone loss, the optimal duration of alendronate therapy may need to be extended, as suggested by the National Comprehensive Cancer Network 2, 3

Treat for 5 years before considering discontinuation in most osteoporotic patients, as recommended by the American College of Physicians 8, 9

After 5 years of alendronate treatment, patients at low-to-moderate fracture risk should take a drug holiday of up to 5 years, while high-risk patients should continue therapy or take a shorter holiday of 1-2 years with close monitoring 8