Is it ever appropriate to restart bipshosphonates following a drug holiday in a patient with a prior atypical hip fracture?
I agree with Dr. @Dr. First Last. I am not likely to ever prescribe a bisphosphonate after someone has had an AFF (or ONJ) attributed to the bisphosphonate. Anabolics make sense if you can get them paid for. Raloxifene is fine but there is no evidence for non-vertebral fracture risk reduction. Venou...
I am not aware of any data on reintroducing bisphosphonates for a patient with a history of an atypical femur fracture. Patients with such fractures are often given anabolic drugs, particularly, the PTH analogues, although their efficacy in promoting fracture healing (or in preventing fracture progr...
It certainly presents a clinical challenge as these are often people who are in their 70s or early 80s who still have osteoporosis or have increased lifetime risk of fracture and may live another 15-25 years. Every one of the ONJ cases or AFF cases I have seen that were sent to me by other physician...
The following reference is viewed to be an excellent source in addressing medical management of OP after AFF:
This string is quite an excellent discussion of osteoporosis management; I do think it would benefit from a discussion of FRAX. Meeting a patient with ONJ or AFF, it is necessary to revisit the FRAX. If the major FRAX is > 20% and/or the hip FRAX is > 3% I discuss risks and benefits of medication us...