Women who discontinue bisphosphonates for two years or more have higher hip fracture risk

November 04, 2017

SAN DIEGO - Women who took a drug holiday (temporary or permanent discontinuation of a medicine) from using bisphosphonates for more than two years have a significantly higher risk of a hip fracture compared to others who continued their treatment, according to new research findings presented this week at the 2017 ACR/ARHP Annual Meeting in San Diego.

Osteoporosis is a common condition that results from loss of bone mass, measured as bone density. People over 50 are at the greatest risk for developing osteoporosis and having bone fractures. Osteoporosis is most common among older women, especially non-Hispanic white and Asian women. Treatment with bisphosphonates, a class of anti-resorptive drugs, may slow bone loss and decrease fracture risk in osteoporosis patients.

Taking a drug holiday from bisphosphonates after years of continuous therapy is becoming more common due to FDA warnings about long-term risks. In a population-based, cohort study, researchers at the University of Alabama at Birmingham investigated the potential impact of stopping bisphosphonates on hip fracture risk among women who are long-term users of these therapies.

The researchers used Medicare data from 2006-2014 to identify 156,236 women who were long-term, adherent users of bisphosphonates, quantified as being at least 80 percent adherent for three or more years. Patients who used other bone therapies, such as denosumab, estrogen, teriparatide or calcitonin, were excluded or censored if they started these treatments after first taking bisphosphonates. The mean age of the women was 78.5 years. The most common bisphosphonates used by the women in the study were alendronate and zoledronic acid.

During a median follow-up period of 2.1 years, 40.1 percent of women stopped bisphosphonate therapy for at least six months or more. Among these women, 12.7 percent restarted a bisphosphonate later. Of all the women in the study, 10.8 percent died during the follow-up period due to various causes.

For the study, the researchers calculated crude rates of hip fracture for those continuing bisphosphonate therapy and those who took a drug holiday, and for the length of the drug holidays.

"Our goal was to evaluate the risk of discontinuing therapy based on the length of the holiday, controlling for any possibly confounding factors, such as race, median income, rural or urban location, DXA scores or comorbidities," said Jeffrey Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology at the University of Alabama at Birmingham, and a lead author of the study.

Results showed that a total of 3,745 hip fractures occurred during follow-up. Hip fracture rates were lowest among the women who continued bisphosphonates and gradually increased as the length of the drug holiday increased. Women who took a drug holiday of more than two years showed the highest rate of hip fractures and were associated with a significantly increased risk for hip fracture of up to 39 percent compared to continued bisphosphonates use.

"While the notion of a drug holiday has become commonplace in osteoporosis management, there's a dearth of evidence on when we should consider restarting bisphosphonate therapy," said Dr. Curtis. "The study's findings may provide useful evidence to help guide rheumatologists as they plan long-term therapy for their patients dealing with low bone mass."

This research was supported by funding from the NIH's National Institute of Arthritis and Musculoskeletal and Skin Diseases.
-end-
About the ACR/ARHP Annual Meeting

The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. With more than 450 sessions and thousands of abstracts, if offers a superior combination of basic science, clinical science, tech-med courses, career enhancement education and interactive discussions on improving patient care. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official #ACR17 hashtag.

About the American College of Rheumatology

The American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit http://www.rheumatology.org.

American College of Rheumatology

Related Osteoporosis Articles from Brightsurf:

New opportunities for detecting osteoporosis
Osteoporosis can be detected through low dose computed tomography (LDCT) imaging tests performed for lung cancer screening or other purposes.

Oxytocin can help prevent osteoporosis
In a laboratory experiment with rats, Brazilian researchers succeeded in reversing natural processes associated with aging that lead to loss of bone density and strength.

New strategy against osteoporosis
An international research team has found a new approach that may be able to reduce bone loss in osteoporosis and maintain bone health.

New review on management of osteoporosis in premenopausal women
An IOF and ECTS Working Group have published an updated review of literature published after 2017 on premenopausal osteoporosis.

Cardiac CT can double as osteoporosis test
Cardiac CT exams performed to assess heart health also provide an effective way to screen for osteoporosis, potentially speeding treatment to the previously undiagnosed, according to a new study.

Osteoporosis treatment may also protect against pneumonia
A recent study published in the Journal of Bone and Mineral Research found that nitrogen-containing bisphosphonates (N-BPs) such as alendronate, which are widely used to treat postmenopausal osteoporosis, are linked with lower risks of pneumonia and of dying from pneumonia.

New pharmaceutical target reverses osteoporosis in mice
Biomedical engineers at Duke University have discovered that an adenosine receptor called A2B can be pharmaceutically activated to reverse bone degradation caused by osteoporosis in mouse models of the disease.

A link between mitochondrial damage and osteoporosis
In healthy people, a tightly controlled process balances out the activity of osteoblasts, which build bone, and osteoclasts, which break it down.

Many stroke patients not screened for osteoporosis, despite known risks
Many stroke survivors have an increased risk of osteoporosis, falls or breaks when compared to healthy people.

Many postmenopausal women do not receive treatment for osteoporosis
The benefits of treating osteoporosis in postmenopausal women outweigh the perceived risks, according to a Clinical Practice Guideline issued today by the Endocrine Society.

Read More: Osteoporosis News and Osteoporosis Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.