A drug holiday from bisphosphonate therapy is a valid strategy in osteoporosis management
A drug holiday from bisphosphonate therapy is a well-established and valid strategy in osteoporosis management, helping to reduce rare adverse events in low- to moderate-risk patients while leveraging the drugs' long skeletal retention.
Multiple clinical guidelines and studies (e.g., papers 4, 5, 6, 8, 10) explicitly discuss and endorse bisphosphonate drug holidays after several years of continuous therapy, particularly for patients at lower risk of fracture, to balance efficacy against rare long-term adverse events. There are no papers refuting the core validity of the strategy, though authors consistently emphasize careful patient selection and monitoring.
Ernest Suresh, Michael Pazianas, Bo Abrahamsen. Safety issues with bisphosphonate therapy for osteoporosis. 2013. https://doi.org/10.1093/rheumatology/ket236
Supports a drug holiday after 5 years for low-risk patients to mitigate rare adverse effects like atypical femoral fracture.
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Jacques P. Brown, Suzanne N. Morin, William D. Leslie, Αλεξάνδρα Παπαϊωάννου, Angela M. Cheung, K. Shawn Davison, David Goltzman, David A. Hanley, Anthony B. Hodsman, Robert Josse, A. Jovaisas, Angela Juby, Stéphanie Kaiser, Andrew C. Karaplis, David L. Kendler, Aliya Khan, Daniel Ngui, Wojciech P. Olszynski, Louis‐Georges Ste‐Marie, Jonathan D. Adachi. Bisphosphonates for treatment of osteoporosis: expected benefits, potential harms, and drug holidays.. 2014. https://openalex.org/W2109300910
Indicates that drug holidays are appropriate for low- to moderate-risk patients after 3 to 5 years of bisphosphonate therapy.
Papapoulos SE, Makras P. Bisphosphonates in the Management of Patients with Postmenopausal Osteoporosis; Back to the Future.. 2025. https://doi.org/10.3390/ph18071068
Explains that bisphosphonates persist in the skeleton after discontinuation, validating drug holidays as a way to reduce rare adverse events while maintaining therapeutic effects.
Kim JW, Kong SH, Kim JY, Kwak MK, Kim JY, Oh JH, Park HY, Kim B, Lee YK, Han JJ, Kim MY, Choi YJ, Kwon YD, Song KS, Kim BJ, Kim SJ, Baek SH, Lee DO, Choi HS, Kim HY, Kwon TG. Medication-Related Osteonecrosis of the Jaw: An Evidence-Based 2025 Position Statement from a Korean Multidisciplinary Task Force.. 2025. https://doi.org/10.3803/enm.2025.2712
Recommends prescriptive drug holidays, such as a 2-month pause for oral bisphosphonates, to minimize surgical complication risks like osteonecrosis of the jaw.
Rukarwa Rutendo, Mohamed Farzahna, Raal Frederick. Impact of a Bisphosphonate Drug Holiday on the Bone Mineral Density in Patients with Osteoporosis. 2021. https://doi.org/10.18772/26180197.2021.v3n2a2
Examines bisphosphonate drug holidays and concludes they are a viable strategy that should be cautiously considered and individualized based on patient risk.
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