Bisphosphonate drug holidays in osteoporosis according to fracture risk profile

December 24, 2024

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Publicated to: OSTEOPOROSIS INTERNATIONAL. 36 (2): 245-254 - 2025-02-01 36(2), DOI: 10.1007/s00198-024-07309-9

Authors:

Salmoral, A; Peris, P; Medina, CL; Flórez, H; Barceló, M; Pastor, MP; Ros, I; Grados, D; Aguado, P; García, S; López, L; Gifre, L; Cerdá, D; Aguilar, FJ; Panero, B; Costa, E; Casado, E; Hernández, B; Ferrer, AM; Graña, J; Gómez, I; Guañabens, N; Spanish Soc Rheumatology

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Affiliations

Hosp Sant Rafael, Dept Rheumatol, Barcelona, Spain - Author

Univ Barcelona, Hosp Clin, Inst Invest Biomed August Pi I Sunyer IDIBAPS, Dept Rheumatol, Barcelona, Spain - Author

Univ Barcelona, Hosp Moises Broggi, Dept Rheumatol, Sant Joan Despi, Barcelona, Spain - Author

Univ Cordoba, Univ Hosp Reina Sofia, Maimonides Inst Biomed Res Cordoba IMIBIC, Dept Rhematol, Cordoba, Spain - Author

Univ Hosp A Coruna, Inst Biomed Res A Coruna INIBIC, Microbiol Dept, La Coruna, Spain - Author

Univ Hosp Germans Trias, Dept Rheumatol, Badalona, Spain - Author

Univ Hosp Igualada, Dept Rheumatol, Barcelona, Spain - Author

Univ Hosp Parc Tauli, Dept Rheumatol, Sabadell, Spain - Author

Univ Hosp Son Llatzer, Dept Rheumatol, Palma De Mallorca, Spain - Author

Univ Hosp Vall dHebron Barcelona, Vall dHebron Res Inst, Dept Rheumatol, Rheumatol Res Grp, Barcelona, Spain - Author

Univ Hosp Virgen de La Victoria, Dept Rheumatol, Malaga, Spain - Author

Univ Hosp Virgen Macarena, Dept Rheumatol, Seville, Spain - Author

Univ La Paz, Dept Rheumatol, Madrid, Spain - Author

Abstract

We analyzed the incidence of fractures and changes in bone mineral density and bone turnover markers in 264 patients who discontinued bisphosphonates. Fractures were recorded in 12.3%. Half were clinical vertebral fractures. We identified patients with a high-risk profile who should not discontinue treatment. Objective The optimal length of bisphosphonate discontinuation is unknown, as is the type of patient who could benefit from this approach. The objectives of the study were to analyze, in clinical practice, the incidence of fractures and associated risk factors, changes in bone mineral density (BMD) and bone turnover markers (BTMs) after discontinuation of bisphosphonates. Methods This observational retrospective study included 264 patients from 14 Spanish rheumatology departments. Postmenopausal women or men with osteoporosis received alendronate or risedronate for >= 5 years or zoledronate for >= 3 years and had discontinued treatment for >= 1 year or >= 2 years, respectively. Spinal X-rays were obtained before discontinuation and in suspected clinical vertebral fracture during follow-up. BMD and BTMs were determined before discontinuation and at different time points. Results The mean discontinuation time was 2.7 (+/- 6.7) years. Thirty-two patients (12.3%) had 36 fractures, mainly clinical vertebral fractures. The main risk factor for fracture was a high-risk profile (femoral neck T-score = 5 years]) before discontinuation. At 12 months, 10.41% of patients with high-risk profile experienced a fracture, being 0.8% and 1.08% in moderate- and low-risk patients, respectively. Significant BMD loss at the femoral neck and total hip was detected, with duration of discontinuation being the key factor. PINP was the marker with the greatest changes. Conclusions We identified a profile of patients with osteoporosis who should not discontinue bisphosphonates, owing to the possibility of fractures, especially vertebral, which are already evident the first year after discontinuation.

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Keywords

AgedAged, 80 and overAlendronateBiomarkersBisphosphonateBone densitometryBone densityBone density conservation agentsBone remodelingBone-mineral densityDensitometria òssiaDiphosphonatesDiscontinuationDrug administration scheduleDrug holidaysExtensionFemaleFracturesFragility fractureHigh risk of fracturHigh risk of fractureHumansIncidenceLong-term treatmentLumbar vertebraeMaleMiddle agedOsteoporosiOsteoporosisOsteoporosis, postmenopausalOsteoporotic fracturesPostmenopausal osteoporosisRetrospective studiesRisk assessmentRisk factorsSpainSpinal fracturesTherapyTriaWithholding treatmentWomenZoledronic acid

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Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal OSTEOPOROSIS INTERNATIONAL due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2025, it was in position 32/193, thus managing to position itself as a Q1 (Primer Cuartil), in the category Endocrinology & Metabolism.

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2026-04-05:

WoS: 1

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Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: Last Author (Guañabens Gay, Núria).

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Awards linked to the item

[FERBT2024] The authors thank the Spanish Foundation of Rheumatology for providing medical editorial assistance during the preparation of the manuscript.

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