Endocrine Society Clinical Practice Guideline: Drug Holiday (2019)

“Bisphosphonate holiday” is recommended in postmenopausal women with osteoporosis who are found to have low-to-moderate risk of fractures after taking bisphosphonates for 3 to 5 years.

 

“Bisphosphonate holiday” is recommended in postmenopausal women with osteoporosis who are found to have low-to-moderate risk of fractures after taking bisphosphonates for 3 to 5 years.

DRUG THERAPY

REASSESS FRACTURE RISK IN

DRUG HOLIDAY/ CONTINUE THERAPY

REASSESS FRACTURE RISK DURING DRUG HOLIDAY

RESTARTING THERAPY AFTER DRUG HOLIDAY

Oral Bisphosphonate

5yrs

Low-moderate risk:

Drug Holiday

 

2-4yrs

High risk/ bone loss:

Restart therapy

IV Bisphosphonate

3yrs

High risk: Continue/switch to another therapy

 

 

Denosumab*

5-10yrs

Low-moderate risk:

Consider giving bisphosphonate then stopping for drug Holiday

 

High risk: Continue/switch to another therapy

1-3yrs

High risk/ fracture/ bone loss:

Restart therapy

 

 

 

 

 

*Drug Holiday is not recommended with Denosumab.

Reference:

Shoback D, et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Guideline Update. J Clin Endocrinol Metab. 2020 Mar 1;105(3).

 

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