TY - JOUR T1 - Bisphosphonates for treatment of osteoporosis JF - Canadian Family Physician JO - Can Fam Physician SP - 324 LP - 333 VL - 60 IS - 4 AU - Jacques P. Brown AU - Suzanne Morin AU - William Leslie AU - Alexandra Papaioannou AU - Angela M. Cheung AU - Kenneth S. Davison AU - David Goltzman AU - David Arthur Hanley AU - Anthony Hodsman AU - Robert Josse AU - Algis Jovaisas AU - Angela Juby AU - Stephanie Kaiser AU - Andrew Karaplis AU - David Kendler AU - Aliya Khan AU - Daniel Ngui AU - Wojciech Olszynski AU - Louis-Georges Ste-Marie AU - Jonathan Adachi Y1 - 2014/04/01 UR - http://www.cfp.ca/content/60/4/324.abstract N2 - Objective To outline the efficacy and risks of bisphosphonate therapy for the management of osteoporosis and describe which patients might be eligible for bisphosphonate “drug holiday.” Quality of evidence MEDLINE (PubMed, through December 31, 2012) was used to identify relevant publications for inclusion. Most of the evidence cited is level II evidence (non-randomized, cohort, and other comparisons trials). Main message The antifracture efficacy of approved first-line bisphosphonates has been proven in randomized controlled clinical trials. However, with more extensive and prolonged clinical use of bisphosphonates, associations have been reported between their administration and the occurrence of rare, but serious, adverse events. Osteonecrosis of the jaw and atypical subtrochanteric and diaphyseal femur fractures might be related to the use of bisphosphonates in osteoporosis, but they are exceedingly rare and they often occur with other comorbidities or concomitant medication use. Drug holidays should only be considered in low-risk patients and in select patients at moderate risk of fracture after 3 to 5 years of therapy. Conclusion When bisphosphonates are prescribed to patients at high risk of fracture, their antifracture benefits considerably outweigh their potential for harm. For patients taking bisphosphonates for 3 to 5 years, reassess the need for ongoing therapy. ER -