Five Years on Alendronate: Should You Take a 'Drug Holiday'?What Experts Advise

Bisphosphonates such as alendronate (a weekly pill) and zoledronic acid (a yearly infusion) are the most commonly used osteoporosis drugs.¹ After a few years, many women ask: do I need to keep taking it?

What the long-term trial showed

In a long-term extension trial, women who took alendronate for 10 years had fewer clinical spine fractures than women switched to placebo after 5 years.¹ So continuing helps some women more than others, which is why your risk matters.

What the task force suggests

The American Society for Bone and Mineral Research task force suggests reassessing after 5 years of pills or 3 years of infusions.¹

• Higher-risk women (older age, low hip T-score, high fracture-risk score, a prior major fracture, or a fracture while on treatment): consider continuing up to 10 years of pills or 6 years of infusions, with regular check-ins.¹
• Women not at high risk after 3 to 5 years: a drug holiday of 2 to 3 years can be considered.¹

The guidance is based on limited evidence, mostly in white women.¹

The rare risk that rises with time

Atypical thigh-bone (femur) fractures become more likely the longer you take a bisphosphonate; jaw problems don’t show the same pattern.¹

In a study of more than 196,000 women:²

• Risk rose with years of use and dropped quickly after stopping.²
• Asian women had about 5 times the risk of white women.²
• Over 3 years in white women, bisphosphonates prevented 149 hip fractures for every 2 atypical fractures; in Asian women it was 91 vs. 8.²
• Overall, the benefits far outweighed this rare risk.²

Warning sign: a new, dull, aching thigh or groin pain, sometimes weeks or months before a fracture. Get it checked.³

Questions to ask at your 5-year review

1. What’s my fracture risk now, based on a bone density scan and risk score?
2. Would a break or continuing be safer for me?
3. How will we monitor during a holiday, and when would I restart?

Our guides to alendronate vs. zoledronate, denosumab arrangements, bone drugs and the jaw and bone density scan coverage cover related decisions.

Try: “I’ve taken alendronate for five years and haven’t broken a bone. Is it time to reassess, and would a drug holiday make sense for me?”

My Body Changed. Now What? includes a Visit Brief. Use it to list your start date, bone density results and any fractures before your review. See the book.