Pharmacological management of osteoporosis - when to treat and when to stop.

INTRODUCTION: Bisphosphonates are antiresorptive drugs of proven efficacy which are widely used for osteoporosis. After stopping bisphosphonate therapy, residual therapeutic effects persist for an undefined period; thus, some osteoporotic patients could benefit from a temporary discontinuation, the so called 'drug holiday'. AREAS COVERED: We reviewed the effects of discontinuing various anti-fracture treatments in order to clarify both clinical features of patients for whom a drug holiday from an initial bisphosphonate treatment period could be offered and a possible approach to the management of the drug holiday. A PubMed search was undertaken using the following main search terms: 'bisphosphonates', 'drug holiday', 'treatment discontinuation', 'anti-fracture drugs'. Expert commentary: After an initial bisphosphonate treatment period of 3-5 years, fracture risk should be reassessed in order to decide if a drug holiday could be offered to patients. Those at high fracture risk should continue treatment; those at moderate-mild fracture risk could temporarily discontinue treatment.