From the Guidelines
For a 79-year-old female with osteoporosis on Fosamax (alendronate), treatment duration should be reassessed after 3-5 years of therapy, and consideration should be given to stopping bisphosphonate treatment after 5 years unless the patient has a strong indication for treatment continuation, as suggested by the most recent guideline from the American College of Physicians 1. The decision to continue or discontinue treatment should be individualized based on the patient's fracture risk assessment, which takes into account factors such as bone density, history of fractures, and multiple risk factors for fractures.
- Key considerations in determining treatment duration include:
- The patient's baseline risk for fracture, which can be assessed using various risk assessment tools 1
- The potential benefits of continued treatment, including reduced risk for new vertebral fractures 1
- The potential harms of long-term bisphosphonate use, including atypical femur fractures and osteonecrosis of the jaw 1
- Regular monitoring with bone density scans every 1-2 years during treatment and reassessment of fracture risk can help guide ongoing management decisions, as recommended by the American College of Physicians 1. The American College of Physicians guideline suggests that clinicians should consider stopping bisphosphonate treatment after 5 years unless the patient has a strong indication for treatment continuation, such as a high risk of fracture or a history of previous fragility fractures 1.
- In patients with a high risk of fracture, continuing treatment for up to 10 years may be appropriate, while in moderate-risk patients, a drug holiday of 1-2 years with monitoring can be considered after the initial treatment period.
- The persistent effect of bisphosphonates in bone tissue even after discontinuation allows for drug holidays in appropriate patients, making it possible to balance the benefits and risks of treatment 1.
From the FDA Drug Label
The optimal duration of use has not been determined. The safety and effectiveness of alendronate sodium for the treatment of osteoporosis are based on clinical data of four years duration. All patients on bisphosphonate therapy should have the need for continued therapy re-evaluated on a periodic basis Patients at low-risk for fracture should be considered for drug discontinuation after 3 to 5 years of use.
The usual duration of treatment with alendronate for a patient with osteoporosis is 3 to 5 years, after which the need for continued therapy should be re-evaluated on a periodic basis 2.
- Patients at low-risk for fracture should be considered for drug discontinuation after this period.
- The optimal duration of use has not been determined, and the safety and effectiveness of alendronate sodium are based on clinical data of four years duration.
From the Research
Duration of Fosamax Treatment
- The optimal duration of treatment with Fosamax (alendronate) for osteoporosis is uncertain 3.
- A study found that discontinuing alendronate after 5 years of treatment did not significantly increase fracture risk, except for clinical vertebral fractures 3.
- However, women at very high risk of clinical vertebral fractures may benefit from continuing treatment beyond 5 years 3.
- The decision to continue or stop treatment should be based on individual patient risk factors and bone density measurements 4.
- There is no specific guidance on the duration of Fosamax treatment in the provided studies, but it is generally recommended to reassess treatment after 5 years 4.
Considerations for Treatment Duration
- The risk of adverse effects, such as osteonecrosis of the jaw, should be considered when determining treatment duration 5, 6.
- Combination therapy with other medications, such as teriparatide, may be considered for patients who do not respond to Fosamax alone 7.
- Patient preferences and adherence to treatment should also be taken into account when determining treatment duration 4.