Osteoporosis medications: Must they be taken indefinitely?

The length of time you must take osteoporosis medications depends on the type of medication and your individual circumstances. With some types of osteoporosis medications, such as estrogen (Cenestin, Premarin, others), calcitonin-salmon (Miacalcin) and raloxifene (Evista), the benefits wane when you stop taking the medication.

Bisphosphonates — another type of osteoporosis medication — may need to be taken indefinitely, too, but that's not always the case. Medications from this drug class include ibandronate (Boniva), alendronate (Fosamax), risedronate (Actonel) and zoledronic acid (Reclast).

To determine whether you need lifelong bisphosphonate therapy, your doctor will likely consider three primary factors:

• What's your risk of an osteoporosis-related fracture? The National Osteoporosis Foundation provides guidelines for assessing fracture risk and determining candidates for drug therapy. According to these guidelines, if you've had an osteoporosis-related fracture, you're considered at high risk of future fractures — and a good candidate for continuing drug therapy. You might consider stopping bisphosphonate therapy, however, if your fracture risk isn't as high as previously thought.
• Will the medication continue to prevent bone loss after you stop taking it? To varying degrees, bisphosphonates help prevent bone loss even after they're discontinued. Data on one drug, alendronate, suggest that it might be appropriate to stop therapy for up to five years if you've taken the medication for five years or longer, you have a low risk of fractures and you're not losing bone density. Other bisphosphonates also may keep working if you discontinue them, especially when the risk of fractures is relatively low. Until more drug-specific information comes out, though, questions about how much medication you need and how long you need it will remain unanswered.
• What's your risk of an adverse effect of long-term bisphosphonate therapy? Rarely, bisphosphonate therapy can lead to osteonecrosis of the jaw — a bone disease that causes pain, swelling or infection in the jaw. Invasive dental procedures, such as tooth extractions, increase this risk, so ask your doctor whether it's advisable to stop your bisphosphonate before you have dental work. Long-term bisphosphonate therapy has also been linked to a rare type of thigh fracture that sometimes develops in both legs at once. This injury, known as atypical femoral fracture, is similar to a stress fracture, causing pain that begins subtly and may gradually worsen. The thigh or groin is the site of the pain. Left untreated, an atypical femoral fracture may extend across and through the bone, breaking it completely. To limit your risk of both these adverse effects, you might consider stopping bisphosphonate therapy if you've taken the medication for five years or longer and you have a low risk of fractures.

Remember, the decision to continue or stop bisphosphonate therapy is an individual one. Consult your doctor to address the risks and benefits of continuing these medications in your case.