The Medical Letter on Drugs and Therapeutics
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1393
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Bisphosphonates - Duration of Use Revisited
Revised 7/6/12: In the first sentence of the conclusion, the words "with osteoporosis" were removed immediately after "women".

Long-term use of bisphosphonates for prevention and treatment of osteoporosis has been associated with osteonecrosis of the jaw, atypical fractures of the femur, and possibly esophageal cancer.1,2 So for how long should patients take them?

CLINICAL STUDIES — The limited evidence comes mainly from 3 studies in postmenopausal women with low bone mineral density.3

The FLEX trial randomized 1099 women who had taken alendronate (Fosamax, and others) for 5 years to continued alendronate or placebo for 5 additional years. Continuation of treatment with alendronate decreased the incidence of clinical vertebral fractures (2.4% vs. 5.3%). It did not decrease the incidence of nonvertebral fractures. A post hoc subgroup analysis found that an additional 5 years of alendronate did reduce the incidence of nonvertebral fractures in patients ... more      

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