Should patients on osteoporosis medications be given a drug holiday? If so, how long should the drug holiday last?
Bisphosphonates are the only osteoporosis medication class for which a drug holiday should currently be considered. Osteoporosis medication drug holidays are not recommended with denosumab, teriparatide, or abaloparatide for reasons stated earlier; if and when these medications are stopped, another agent should be substituted.
Bisphosphonate drug holidays may be considered after a patient has had the optimum duration of treatment (see previous question). Bisphosphonate drug holidays should end under the following circumstances:
- • A fragility fracture (spine, hip, wrist, and humerus) occurs.
- • Bone density decreases more than the least significant change (LSC) established for that specific instrument (see discussion of LSC later).
- • Bone turnover markers (urine N-telopeptide, serum C-telopeptide, serum bone-specific alkaline phosphatase) increase by >30% or rise into the upper 50% of the reference range.