➤ 2.2 In postmenopausal women with osteoporosis who are taking
bisphosphonates, ES recommends that fracture risk be reassessed after 3-5
years, and women who remain at high risk of fractures should continue therapy,
while those who are at low-to-moderate risk of fractures should be considered
for a "bisphosphonate holiday." (1|⊕⊕
)
Technical Remarks:
▶ A bisphosphonate holiday is operationally defined as a temporary discontinuation of
bisphosphonate for up to 5 years. This period may be longer depending on the BMD and
clinical circumstances of the individual patient.
▶ The evidence is stronger for retention of benefits during a holiday for alendronate and
zoledronic acid where there are randomized extension trials.
▶ A shorter reassessment period of 3 years is more appropriate for annual intravenous
zoledronic acid (5 mg ) based on evidence from RCTs showing residual effects after 3 years of
annual use.
▶ Once a bisphosphonate holiday is initiated, reassess fracture risk at 2- to 4-year intervals
and consider reinitiating osteoporosis therapy earlier than the 5-year suggested maximum if
there is a significant decline in BMD, an intervening fracture, or other factors that alter the
clinical risk status.
Denosumab
➤ 3.1 In postmenopausal women with osteoporosis who are at high risk for
osteoporotic fractures, ES recommends using denosumab as an alternative
initial treatment. (1|⊕⊕⊕⊕)
Technical Remarks:
▶ The recommended dosage is 60 mg subcutaneously every 6 months.
▶ The effects of denosumab on bone remodeling, reflected in bone turnover markers, reverse
after 6 months if the drug is not taken on schedule. Thus, a drug holiday or treatment
interruption are not recommended with this agent.
➤ 3.2 In postmenopausal women with osteoporosis who are taking denosumab, ES
suggests that the fracture risk be reassessed after 5-10 years and that women
who remain at high risk of fractures should either continue denosumab or be
treated with other osteoporosis therapies. (2|⊕
)
➤ 3.3 In postmenopausal women with osteoporosis taking denosumab,
administration of denosumab should not be delayed or stopped without
subsequent antiresorptive (e.g., bisphosphonates, HT or SERM) or other therapy
administered in order to prevent a rebound in bone turnover and to decrease the
risk of rapid BMD loss and an increased risk of fracture (UGPS).
Teriparatide and Abaloparatide
➤ 4.1 In postmenopausal women with osteoporosis at very high risk of fracture,
such as those with severe or multiple vertebral fractures, ES recommends
teriparatide or abaloparatide treatment for up to two years for the reduction of
vertebral and nonvertebral fractures. (1|⊕⊕⊕
)
Treatment and Management
