Long-term use of bisphosphonates in osteoporosis

Alexandra Papaioannou, MD, MSc, is a professor of medicine in the Divisions of Geriatric Medicine & Rheumatology at McMaster University and the lead investigator for the Long-term Care Ontario Osteoporosis Strategy. She has expertise in clinical practices that involve osteoporosis and frailty in older adults.

When is the long-term bisphosphonate use justified in the treatment of osteoporosis and when can it be paused? How to monitor patients receiving this treatment?

Alexandra Papaioannou, MD, MSc: This is a very interesting and topical question. Most of the research has shown that approximately in year 5 to 6, the risk of osteonecrosis of the jaw and atypical fractures increases and the benefits of these drugs in terms of improving bone density and fracture therapy really seem to decline compared to their benefits. So, the risks start outweighing the benefits around year 5 to 6.

Most societies have said at that time you need to consider alternate treatment, such as an anabolic or denosumab, if they continue to be high risk; or have a pause in treatment and reassess these individuals in 2 to 3 years with the bone density. Some countries use bone markers as well.