What strategy do you use to determine the appropriate timing to resume osteoporosis therapy after a drug holiday?

A drug holiday (drug sabbatical) is given to reduce the likelihood of an atypical femur fracture. Such fractures have characteristic x-ray appearances and are found from below the lesser trochanter to the supracondylar flare of the distal femur. While the overall incidence of these fractures is low, they do occur with increasing frequency with longer term use of bisphosphonates. In general, most patients are advised to stop the use of this class of drugs after three to five years of continuous u...

Dr. @Dr. First Last has provided an excellent response and describes a well-thought out approach to drug holiday duration. I fully agree with his recommendations. I would add that it is important to re-assess patients regularly during the period of the drug holiday to determine if there has been an intervening fragility fracture, or a change in the patient's health such as increased fall risk or use of glucocorticoids or other medications that may affect bone health. The patient may need to resu...