Continuation of Bisphosphonate Therapy for Osteoporosis beyond 5 Years

This clinical decision feature presents a 71 year old postmenopausal woman with osteoporosis (femoral neck T score 2.7) who completed 5 years of alendronate therapy without fractures. Experts debate two management options:

1. Continue bisphosphonates (Eastell): Cites FLEX trial data showing reduced vertebral fracture risk with extended therapy, especially in patients with T scores ≤2.5. Advocates adherence assessment and consideration of intravenous zoledronate if oral therapy is suboptimal.

2. Discontinue with monitoring (Miller): Highlights risks of atypical femur fractures with prolonged use and recommends a "drug holiday," monitoring bone density/turnover markers to guide reinitiation.

The discussion balances fracture prevention benefits against long-term risks, emphasizing individualized decision-making.

This clinical decision feature presents a 71 year old postmenopausal woman with osteoporosis (femoral neck T score 2.7) who completed 5 years of alendronate therapy without fractures. Experts debate two management options:

1. Continue bisphosphonates (Eastell): Cites FLEX trial data showing reduced vertebral fracture risk with extended therapy, especially in patients with T scores ≤2.5. Advocates adherence assessment and consideration of intravenous zoledronate if oral therapy is suboptimal.

2. Discontinue with monitoring (Miller): Highlights risks of atypical femur fractures with prolonged use and recommends a "drug holiday," monitoring bone density/turnover markers to guide reinitiation.

The discussion balances fracture prevention benefits against long-term risks, emphasizing individualized decision-making.