MS Speaks

People with MS seem particularly susceptible to osteoporosis, and doctors like to prescribe bisphosphanates (like Fosamax) for this condition. It now turns out that you shouldn't take these drugs indefinitely--in fact,  taking one for more than a few years might put you at greater fracture risk.

From NEJM Journal Watch, October 12, 2017:

SUMMARY AND COMMENT

For Bisphosphonate Therapy, Longer Is Not Necessarily Better

Andrew M. Kaunitz, MD reviewing Drieling RL et al. J Am Geriatr Soc 2017 Sep .

Data from the WHI provide guidance about optimal duration of use.

Although bisphosphonates' efficacy in preventing fragility fractures is well established, questions persist about optimal duration of use. Some 97,000 participants in the Women's Health Initiative (WHI) observational and randomized trials completed medication forms. Among a subgroup of 5120 women (mean age, 80; 94% white) with estimated 5-year hip fracture risk ≥1.5% and ≥2 years of self-reported bisphosphonate use, investigators assessed risk for incident fractures following various durations of bisphosphonate therapy (2 years, 3–5 years, 6–9 years, and 10–13 years).

During additional mean follow-up of 3.7 years, fracture rates were 2% for hip fractures, 3% for radius or forearm fractures, 5% for clinical vertebral fractures, and 26% for any clinical fracture. Adjusted analysis showed that, compared with 2 years of bisphosphonate use, 10 to 13 years of use was associated with a modestly but statistically significantly higher risk for any clinical fracture (hazard ratio, 1.29; 95% confidence interval, 1.07–1.57). Risks after 10 to 13 years of use were even higher for hip fractures (HR, 1.66) and clinical vertebral fractures (HR, 1.65), although these did not reach statistical significance, possibly because of the small numbers in these subgroups. Compared with 2 years' use, 3 to 5 and 6 to 9 years' use did not confer excess fracture risk overall or at specific sites.

COMMENT

This study — the largest to assess fracture risk in older, female, long-term bisphosphonate users — supports discontinuing therapy after 2 to 5 years. As an editorialist notes, whether (and when) to restart bisphosphonate therapy after a drug holiday depends on which agent has been used and the patient's underlying fracture risk.