Abstract
The amino-bisphosphonates are first-line therapy for the treatment of most patients
with osteoporosis, with proven efficacy to reduce fracture risk at the spine, hip,
and other nonvertebral skeletal sites. Further, bisphosphonates have been associated
with a significant decrease in morbidity and increase in survival. Following the use
of bisphosphonates in millions of patients in clinical practice, some unexpected possible
adverse effects have been reported, including osteonecrosis of the jaw, atypical femur
fractures, atrial fibrillation, and esophageal cancer. Because bisphosphonates are
incorporated into the skeleton and continue to exert an antiresorptive effect for
a period of time after dosing is discontinued, the concept of a drug holiday has emerged,
whereby the risk of adverse effects might be decreased while the patient still benefits
from antifracture efficacy. Patients receiving bisphosphonates who are not at high
risk for fracture are potential candidates for a drug holiday, while for those with
bone mineral density in the osteoporosis range or previous history of fragility fracture,
the benefits of continuing therapy probably far outweigh the risk of harm.
Keywords
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Article info
Publication history
Published online: November 21, 2012
Footnotes
Funding: Unrestricted educational grants from Eli Lilly, Warner-Chilcott, Merck, Novartis, and Amgen were provided to the Western Osteoporosis Alliance for the development of this manuscript. The granting companies had no role in the development of the manuscript or any input as to where or if the resulting manuscript was submitted for publication.
Conflict of Interest: M.R. McClung: Sponsored presentations: Amgen, Lilly, Merck, Novartis, and Warner-Chilcott. Consultation and/or Advisory Board: Amgen, Lilly, Merck, Novartis, and Warner-Chilcott. Grant/research support: Amgen and Merck. S.T. Harris: Sponsored presentations: Amgen, Eli Lilly & Company, Genentech, Gilead Sciences, Novartis, Roche, and Warner Chilcott. Consultation and/or Advisory Board: Amgen, Eli Lilly & Company, Gilead Sciences, Merck, and Roche. P.D. Miller: Sponsored presentations: Procter & Gamble Pharmaceuticals, Amgen, Novartis Pharmaceuticals, Roche Pharmaceuticals. Consultation and/or Advisory Board: Procter & Gamble Pharmaceuticals, Merck & Co., Eli Lilly, Amgen, Novartis Pharmaceuticals, Roche Pharmaceuticals, GlaxoSmithKline, Baxter, and Wright. Scientific grants: Procter & Gamble Pharmaceuticals, Sanofi/Aventis Pharmaceuticals, Roche, Pharmaceuticals, Eli Lilly, Merck & Co., Novartis Pharmaceuticals, Amgen, Takeda, Radius, and GE. D. Bauer: Scientific grants: Novartis and Amgen. K.S. Davison: Sponsored presentations: Amgen, Merck, Novartis, Warner-Chilcott. Consultation and/or Advisory Board: Amgen, Merck, Novartis, Warner-Chilcott. L. Dian: Sponsored presentations: Merck, Pfizer, Lilly and Co., Amgen, Warner Chilcott. Consultation and/or Advisory Board: Merck, Pfizer, Lilly and Co., Amgen, Warner Chilcott. D.A. Hanley: Sponsored presentations: Amgen, Merck, Eli Lilly, Novartis, Warner-Chilcott. Consultation and/or Advisory Board: Amgen, Merck, Eli Lilly, Novartis, Warner-Chilcott. Grant/research support: Amgen, Merck, Pfizer, NPS Pharmaceuticals, Eli Lilly, Novartis, Aventis/Procter and Gamble (now Warner-Chilcott). D.L. Kendler: Sponsored presentations: Novartis, Merck, Eli Lilly, Amgen, Warner Chilcott. Consultation and/or Advisory Board: Pfizer, Novartis, Merck, Eli Lilly, Amgen. Research grants: J&J, GSK, Pfizer, Novartis, Merck, Eli Lilly, Amgen. C.K. Yuen: Sponsored presentations: Pfizer, Merck and Amgen. Consultation and/or Advisory Board: Pfizer, Merck and Amgen. E.M. Lewiecki: Sponsored presentations: Amgen, Eli Lilly, Novartis. Consultation and/or Advisory Board: Amgen, Eli Lilly, Novartis, Merck & Co., GSK. Grant/research support: Amgen, Eli Lilly, Novartis, Merck, Warner Chilcott, GSK.
Authorship: All authors had access to the data and a role in writing the manuscript.
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