American Society for Bone and Mineral Research (Virtual)
American Society for Bone and Mineral Research (Virtual)
October 05, 2018
1 min read

Bisphosphonate drug ‘holidays’ increase fracture risk in women

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact

Discontinuing the use of bisphosphonates for more than 2 years has been linked to increase risk for hip fracture in women, according to research presented at the ASBMR 2018 annual meeting.

“Knowing whether to put people on a bisphosphonate drug holiday, and for how long, is probably one of the leading questions in the bone field facing clinicians these days,” Jeffrey Curtis, MD, MS, MPH, Harbert-Ball endowed professor of medicine in the division of clinical immunology and rheumatology at the University of Alabama at Birmingham, told Endocrine Today. “It’s unlikely that we will have a large-scale clinical trial to answer this question.”

Curtis and colleagues reviewed Medicare data collected between 2006 and 2015 from 160,369 women who began bisphosphonate treatment for at least 3 years. All participants had an 80% or higher adherence rate. Among those women, 36% stopped taking bisphosphonates for a year or longer.

All participants returned for follow-up after a median of 2.7 years (range, 1.5-4.1 years). Researchers found that hip fracture rates were statistically significantly higher for those who took a “drug holiday” than those who continued treatment. Women who discontinued bisphosphonate use for 2 or more years experienced 4,823 reported hip fractures, for an adjusted HR of 1.22 (95% CI, 1.11-1.34) compared with those who used bisphosphonate drugs continuously.

“We need a better understanding of the optimal duration of a drug holiday depending on how long people have been on bisphosphonates. In our study, the minimum use was 3 years, and people had received somewhat more therapy (eg, 4-5 years) before they took a drug holiday, but for someone who has been on a bisphosphonate a very long time (eg, > 5 years), they might be able to take a longer drug holiday,” Curtis said. “We also need a better understanding on how to contextualize the benefits and risks of a drug holiday against other safety concerns for continued bisphosphonate use, including osteonecrosis of the jaw and atypical femoral shaft fractures.” – by Phil Neuffer


Curtis J, et al. Abstract 1006. Presented at: American Society for Bone and Mineral Research Annual Meeting; Sept. 28-Oct. 1, 2018; Montreal.

Disclosures: Curtis reports he is a consultant for Amgen and Radius. Please see the study for all other authors’ relevant financial disclosures.