Duration of therapy is very important to discuss for the ongoing assessment of benefits and risks associated with anti-osteoporosis medication, Dr. Humphrey stresses. “We have seen many physicians recommend drug holidays, but research has indicated that patients on these drug holidays will revert back to an osteoporotic bone mineral density over five years. So monitoring is important to help indicate when therapy should be restarted,” she says.4
Help Patients Do Their Part
It’s important to educate patients about how anti-osteoporosis medications work and their risks, such as dental issues that occur late in therapy, Dr. Humphrey notes.
“We remind patients while on certain anti-osteoporosis [therapies], including bisphosphonates and denosumab, to get in to see the dentist regularly and remind the primary care physician and dentist they are on these meds,” she says. “The dental provider can take conservative preventive measures, such as a root canal to avoid tooth extraction, when possible.”
Additionally, it’s important to talk to patients about other medical risk factors, such as poorly controlled diabetes, high-dose steroids and chemotherapy, associated with osteonecrosis of the jaw, which is rarely seen with anti-osteoporosis treatments.
“All patients have the power to make important lifestyle decisions that can protect their bone health, such as smoking cessation, reduced alcohol intake and adherence to autoimmune disease control, particularly for patients with rheumatoid arthritis,” Dr. Humphrey says. “Rheumatologists can provide regular reminders about these actions to significantly improve a patient’s osteoporosis risk management and overall bone health.”
Carina Stanton is a freelance science journalist based in Denver.
References
- Barton DW, Behrend CJ, Carmouche JJ. Rates of osteoporosis screening and treatment following vertebral fracture. Spine J. 2018 Aug 22. pii: S1529-9430(18)31092-1.
- Jha S, Wang Z, Laucis N, et al.Trends in media reports, oral bisphosphonate prescriptions, and hip fractures 1996–2012: An ecological analysis. J Bone Miner Res. 2015 Dec;30(12):2179–2187
- Hall SF, Wright NC, Wolinsky FD, et al. The prevalence of overtreatment of osteoporosis: Results from the PAADRN trial. Arch Osteoporos. 2018 Sep 28;13(1):103.
- Black DM, Schwartz AV, Ensurd KE, et al. Effects of continuing or stopping alendronate after 5 years of treatment: The fracture intervention trial long-term extension (FLEX): A randomized trial. JAMA. 2006 Dec 27;296(24):2927–2938.
