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Osteoporosis Special Report

Is it Ever Okay To Discontinue Your Osteoporosis Medication?

This Special Report is intended for readers interested in learning about the prevention, diagnosis, and management of osteoporosis.

Have you ever run out of your osteoporosis medication and waited days, weeks, or even months before you refilled the prescription? Such behavior is all too common. Half of all individuals with osteoporosis stop taking their medication for months at a time, then begin using it regularly again. But just as yo-yo dieting isn’t a good way to lose and maintain weight, stopping and restarting prescription medicine for osteoporosis is not the best way to build and maintain your bones.

The cornerstones of drug therapy for osteoporosis are oral bisphosphonates: alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel). Some oral bisphosphonates are meant to be taken daily for osteoporosis, while others should be taken once a week or once a month. By faithfully following the prescribed regimen, you can reduce your risk of fracture from osteoporosis by up to 60%. For the best results, the latest research suggests you’ll have to keep up with that regimen for at least five years before you can consider stopping.

Why do some people stop taking their osteoporosis medication? There are many possible reasons. For instance, you may not see any visible benefit from drug therapy; therefore, you may not feel motivated to continue. Or you might experience gastrointestinal side effects, such as upset stomach or heartburn, which lead you to discontinue your osteoporosis medications. Also, the dosing instructions can be difficult to follow.

If regular use is a problem, ask your doctor if you can switch to a less frequent osteoporosis medication regimen. Many studies show that the fewer doses of bisphosphonates you need to take, for example, weekly rather than daily, the more likely it is that you’ll use them regularly. If oral bisphosphonates upset your stomach, intravenous preparations such as I.V. ibandronate (given every three months) or I.V. zoledronic acid (given yearly) are available.

If you’re using a daily or weekly osteoporosis medication and you take it at least three out of every four weeks each month, you can substantially reduce your risk of fracture from osteoporosis. A multicenter study of more than 35,000 postmenopausal women evaluated the relationship between adherence and nonadherence to bisphosphonate prescriptions and risk of fractures.

The investigators found that just under half of the women refilled their osteoporosis prescriptions in two years, and only 20% of them kept taking bisphosphonates for that entire time. The women who continuously used their osteoporosis medications for two years had fewer fractures at all locations, including the spine and hip, and reduced their risk of these fractures by 20–45%, compared with women who took their medicine less frequently. Women who took the bisphosphonates two out of every four weeks each month also showed some reduction in fracture risk, but not as much as more frequent users.

 

What that means is if you currently take bisphosphonates for your osteoporosis only half of the time, you will benefit only slightly from bisphosphonate therapy but if you want to significantly reduce your fracture risk, you’ll need to take your medication at least three quarters of the time. Of course, all of the time is still best.

 

If you take a bisphosphonate for five years, you may be able to take a break from therapy -- what doctors call a drug holiday. That’s one of the results of the Fracture Intervention Trial Long-term Extension study of more than 1,000 postmenopausal women.

The Bottom Line on Osteoporosis Medication: Long-term use of bisphosphonates for osteoporosis appears to be safe and continues to reduce fracture risk. But research suggests that some patients who are not at increased risk for vertebral fracture can consider discontinuing bisphosphonate therapy after five years with the guidance of their doctor. Whether therapy is cyclical or continuous, adherence to the recommended treatment regimen is crucial for a good outcome.

Posted in Osteoporosis on September 19, 2008

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