Osteoporosis: Drug Breaks Can Lead to Bone Fractures | Loyola Medicine
Thursday, May 3, 2018

Osteoporosis Patients Who Take "Drug Holidays" Suffer Bone Fractures

 
MAYWOOD, IL – Patients who take osteoporosis drugs for long periods typically are advised to temporarily discontinue the drugs to prevent rare but serious side effects to the jaw and thighs.
 
A Loyola Medicine study has found that 15.4 percent of patients who take so-called "drug holidays" from osteoporosis drugs called bisphosphonates experienced bone fractures. During a six-year follow-up period, the yearly incidence of fractures ranged from 3.7 percent to 9.9 percent, with the most fractures occurring during the fourth and fifth years.
 
The study by senior author Pauline Camacho, MD, and colleagues was published in the journal Endocrine Practice.
 
Patients at high risk of fracture who take drug holidays should be closely followed, especially as the drug holiday lengthens, researchers wrote.
 
Bisphosphonates are the most common medications prescribed for osteoporosis. The drugs slow down the breakdown of bones, helping to maintain bone density and reduce the risk of fractures.
 
Bisphosphonates have been linked to osteonecrosis of the jaw (ONJ) and atypical femur fracture. ONJ occurs when the jawbone is exposed, typically following a dental procedure, and begins to weaken and die. An atypical femur fracture is an unusual fracture of the thigh bone that can occur even with normal weight bearing.
 
To reduce the risk of these side effects, the American Association of Clinical Endocrinologists and American College of Endocrinology recommend that women at moderate risk for osteoporosis take a drug holiday after five years of oral and three years of intravenous bisphosphonate treatment. Women at higher risk for osteoporosis should take a drug holiday after 10 years of oral and six years of intravenous bisphosphonate treatment.
 
However, there is minimal data on how long drug holidays should last. The Loyola study was designed to further characterize the increased fracture risk in patients taking drug holidays. The retrospective study examined the records of 371 women and 30 men with osteoporosis or osteopenia who began drug holidays. (Patients with osteopenia have weak bones, but not yet osteoporosis.) The patients had taken bisphosphonates for an average of 6.3 years before beginning drug holidays. The two most frequently prescribed bisphosphonates were alendronate (Fosamax®), taken by 62 percent of patients, and risedronate (Actonel®), taken by 34 percent of patients.
 
Sixty-two patients (15.4 percent) experienced fractures after going on drug holidays. The most common sites were the wrist, foot, ribs and spine. (Foot fractures are not currently considered osteoporotic fractures.) Those most likely to experience fractures were older and had lower bone mineral density at the beginning of the study. Following fractures, patients were put back on bisphosphonates.
 
Drug holidays need further assessment, Dr. Camacho and colleagues wrote. "Patients who begin drug holidays at high risk for fracture based on bone mineral density, age or other clinical risk factors warrant close follow-up during the holiday, especially as its duration lengthens. Fracture risk needs to be regularly assessed during the drug holiday and treatment resumed accordingly."
 
In addition to Dr. Camacho, other co-authors are Brittany Bindon, MD, (first author), William Adams, PhD, Neelam Balasubramanian and Jasmin Sandhu, MD.
 
The study is titled, "Osteoporotic Fractures During Bisphosphonate Drug Holiday."
 

About Loyola Medicine

Loyola Medicine is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC) in Maywood, Gottlieb Memorial Hospital (GMH) in Melrose Park, MacNeal Hospital in Berwyn and convenient locations offering primary and specialty care services from more than 1,772 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. The medical center campus is also home to Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. GMH is a 247-licensed-bed community hospital with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments in a convenient community setting. Loyola Medicine is a member of Trinity Health, one of the nation’s largest health systems with 94 hospitals in 22 states.

About Trinity Health

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 93 hospitals, as well as 122 continuing care programs that include PACE, senior living facilities, and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $17.6 billion and assets of $23.4 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity Health employs about 131,000 colleagues, including 7,500 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity Health is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services — ranked by number of visits — in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs. For more information, visit www.trinity-health.org. You can also follow @TrinityHealthMI on Twitter.