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“Drug Holidays” Being Prescribed for Bisphosphonate Users

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It seems concerns about the safety of Fosamax and similar bone drugs known as bisphosphonates have some doctors reconsidering their long-term use. Just last month, the US Food & Drug Administration (FDA) added warnings to the labels of Fosamax and other oral bisphosphonates after studies showed long-term use of the drugs could be linked to a rare type of thigh fracture. The drugs are also known for their association with osteonecrosis of the jaw (ONJ), or dead jaw syndrome.

According to a report from the Los Angeles Times, some doctors are starting to tell at least some of their patients to go on a “drug holiday” from bisphosphonates like Fosamax.

“To give high doses indefinitely is not what you want to do,” Dr. Ian Reid, an endocrinologist and bone expert at the University of Auckland in New Zealand, told the Times. “After five years, it’s a good time to reassess. If the bones don’t show osteoporosis, we typically stop the drug and monitor bone density. If they still have osteoporosis readings or have had a fracture, we keep them on medications for out to 10 years.”

There are some alternatives to bisphosphonates, the Times said. These include the parathyroid hormone drug teriparatide (sold under the brand name Forteo), which, unlike the bisphosphonates, works by actively building bone. A separate class of drugs called RANK ligand inhibitors, such as Prolia, which works by suppressing bone breakdown by inactivating a protein called the RANK ligand, is also an option. Selective estrogen receptor molecules also help preserve bone mass. Some of these drugs, including raloxifene and tamoxifen, are primarily used to treat breast cancer after menopause, the Times said.

Some doctors are also pulling back from prescribing osteoporosis medications for people who have some bone loss but do not meet the diagnostic criteria for osteoporosis.

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