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Bone diseases

Bisphosphonates in osteoporosis—beyond 5 years

Bisphosphonates are the mainstay of treatment for osteoporosis, but uncertainties exist regarding their long-term use. The identification of patients who will benefit from continuing therapy is of primary clinical importance and a subject of current research. Risk factors for fractures are helping to improve decision making, but unanswered questions remain.

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Figure 1: Uptake and release of bisphosphonates from bone.

References

  1. Whitaker, M., Guo, J., Kehoe, T. & Benson, G. Bisphosphonates for osteoporosis—where do we go from here? N. Engl. J. Med. 366, 2048–2051 (2012).

    Article  CAS  Google Scholar 

  2. Schwartz, A. V. et al. Efficacy of continued alendronate for fractures in women with and without prevalent vertebral fracture: the FLEX trial. J. Bone Miner. Res. 25, 976–982 (2010).

    Article  CAS  Google Scholar 

  3. Black, D. M., Bauer, D. C., Schwartz, A. V., Cummings, S, R & Rosen, C. J. Continuing bisphosphonate treatment for osteoporosis—for whom and for how long? N. Engl. J. Med. 366, 2051–2053 (2012).

    Article  CAS  Google Scholar 

  4. McNabb, B. L. et al. BMD changes and predictors of increased bone loss in postmenopausal women following a 5-year course of alendronate. J. Bone Miner. Res. doi:10.1002/jbmr.1864.

  5. Black, D. M. 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 296, 2927–2938 (2006).

    Article  CAS  Google Scholar 

  6. Khan, S. A. et al. Elimination and biochemical responses to intravenous alendronate in postmenopausal osteoporosis. J. Bone Miner. Res. 12, 1700–1707 (1997).

    Article  CAS  Google Scholar 

  7. Papapoulos, S. E. & Cremers, S. C. L. M. Prolonged bisphosphonate release after treatment in children. N. Engl. J. Med. 356, 1075–1076 (2007).

    Article  CAS  Google Scholar 

  8. Landman, J. O., Hamdy, N. A. T., Pauwels, E. K. J. & Papapoulos, S. E. Skeletal metabolism in patients with osteoporosis after discontinuation of long term treatment with oral pamidronate. J. Clin. Endocrinol. Metab. 80, 3465–3468 (1995).

    Article  CAS  Google Scholar 

  9. Black, D. M. et al. The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: A randomized extension to the HORIZON-Pivotal Fracture Trial (PFT). J. Bone Miner. Res. 27, 243–254 (2012).

    Article  CAS  Google Scholar 

  10. Eastell, R., Hannon, R. A., Wenderoth, D., Rodriguez-Moreno, J. & Sawicki, A. Effect of stopping risedronate after long-term treatment on bone turnover. J. Clin. Endocrinol. Metab. 96, 3367–3373 (2011).

    Article  CAS  Google Scholar 

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S. E. Papapoulos declares that he has acted as a consultant for and received speakers' fees from Amgen, Merck, Novartis, Roche/GSK and Warner Chilcott.

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Papapoulos, S. Bisphosphonates in osteoporosis—beyond 5 years. Nat Rev Rheumatol 9, 263–264 (2013). https://doi.org/10.1038/nrrheum.2013.57

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