Ten vs Five Years of Bisphosphonate Treatment for Postmenopausal Osteoporosis
Enough of a Good Thing
Cathleen S. Colón-Emeric, MD, MHSc
JAMA. 2006;296:2968-2969.
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In the 10 years since the first results from the Fracture Intervention Trial (FIT) were published,1-2 it has been relatively straightforward to know when to start bisphosphonate therapy for women with postmenopausal osteoporosis. Clear fracture reduction benefit was shown for women with prior vertebral fracture or bone mineral density (BMD) T scores of –2.5 or lower. However, the issue of when to stop bisphosphonate therapy is less clear, and clinical practice guidelines have been almost completely silent on this important decision point.3
Pharmacokinetic studies in both humans and animals have demonstrated that bisphosphonates bind tightly to hydroxyapatite and are retained for prolonged periods in bone, where they become locally active again when that bone packet is resorbed.4 This property raised the possibility of both prolonged clinical effectiveness and prolonged risk of harm. Previous clinical studies showed that up to 10 years of alendronate therapy was . . . [Full Text of this Article]
Author Affiliations: Duke University Medical Center, Durham, NC.
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