Patients on long-term alendronate/risedronate should be reassessed after 4 to 5 years:
- If their P1NP (bone turnover marker) is < 35 mcg/l and their femoral T-score is better than -2.5 and there are no new fractures, they can have a drug holiday (oral medication only) for 4 to 5 years.
- If T-score is worse than -2.5 or new fracture then continue treatment for 4-5 more years of oral medication and reassess (consider a 1-2 year drug holiday in this period).
After 5 to 10 years of oral treatment, consider a 1-2 year holiday.
IV zoledronate is an alternative option, given every 18 to 24 months for 3-4 doses, then every 3 years if T-score remains worse than -2.5. In those on oral bisphosphonate with PINP > 35 μg/L, a change to IV is often indicated.
Bisphosphonates prevent fractures without the need for calcium supplements, though vitamin D should be provided to those at risk of deficiency (frail elderly, institutionalised etc).1
This Gem has been checked by Professor Ian Reid, University of Auckland.
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