Data can aid in determining duration of therapy
These data are extremely helpful, especially for clinicians who are trying to determine how long to continue bisphosphonate therapy and which patients may be candidates for a “drug holiday.” We have all had women whose response to a bisphosphonate has been so robust that follow-up BMD measurements have climbed to a range in which therapy would not have been initiated. This study clearly shows that the cumulative effect of 5 years of alendronate followed by 5 years of placebo is positive, compared with the bone loss one would expect in untreated women.
Who should take a holiday from alendronate—and when should it end?
The answer isn’t clear, but women with a previous fracture, and those at high risk for spine fracture, are likely to benefit from continued treatment with alendronate. Patients with a lower risk of fracture are better candidates for the holiday.
As for when the drug holiday should end, that isn’t clear, either. Continued close monitoring of these lower-risk women using bone-density measurements may help identify that minority of patients who do not maintain bone mass off the medication.