Although little evidence is available for men, the approach advocated by the task force can be considered generally applicable to older men, the task force says. It is assumed that men on long-term bisphosphonate therapy have safety issues similar to postmenopausal women, with no greater risk identified in men. The task force indicates it is reasonable to continue treatment in men on long-term bisphosphonate therapy who have a history of hip, spine or multiple other osteoporotic fractures or major osteoporotic fracture while on therapy. A drug holiday of two or three years is reasonable for men who are not considered at high risk because of age or other risk factors, such as androgen-deprivation therapy for prostate cancer. Men at higher risk could continue treatment and be reassessed for a drug holiday in two to three years, according to the report.
Clinical Judgment
No trials have evaluated the antifracture efficacy of switching therapies after three to five years of bisphosphonate treatment, none have extended beyond 10 years, and none have assessed the utility of reinitiation of treatment after a drug holiday, the report states. Because of this lack of data, the task force strongly recommends a tailored approach that includes assessment of each patient’s individual risk profile, shared decision making with the patient and careful follow-up. “The clinician caring for the patient with the chronic disorder of osteoporosis will need to use the art in addition to the science of medicine,” with the approach created by the task force being one tool that will help in decision making, the report says.
Several cases included in the report’s appendix illustrate the challenges of clinical care for patients with osteoporosis. Drs. Adler and El-Hajj Fuleihan say that a clinician has to periodically assess the patient’s risks in view of their evolving profile and the accumulating new evidence: Are there new risks? Does the patient fall? Is the patient taking medications properly? What are new pharmacologic and nonpharmacologic interventions that can be used to decrease fracture risk in a given patient?
“The clinician will complement the evidence derived from scientific studies with the art of practicing medicine to make a reasonable and individualized treatment plan, engaging the patient in the process,” they say.
Kathy L. Holliman, MEd, is a medical writer based in Beverly, Mass.
Reference
- Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: Report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2016;31(1):16–35.
