It's mostly due to the suggestion that the drug's long retention time in bone may result in persistent inhibition of osteoclastic activity for months or years after discontinuation. Patients dislike taking bisphosphonates, and most of them are rather expensive.Why the 'drug holiday'? What are the concerns over longterm usage?
Right now, there's no real evidence that bisphosphonates produce "bad bone." We should continue to treat patients (especially those at high risk for fracture) as aggressively as appropriate.I've 'heard' for awhile now that longterm use of bisphosphonates may actually weaken bone and cause fractures, despite their shortterm benefits. Evidence is emerging to this effect and should alter how these drugs are used.
From Medscape Medical NewsLink?
My instinct (disclaimer: 4th year medical student) would be probably not. Things these days have a tendency to get sensationalized fairly easily and its not worth patients going off the meds and breaking their hips as opposed to staying on the meds and breaking their femurs. At least, from a morbidity and mortality standpoint. This would, of course, be different if the studies were stronger.Is it appropriate to at least mention these new findings to patients who are in the affected group?
The FDA has already responded. See the link I posted earlier. They found no connection between bisphosphonates and femur fractures."The question is whether or not the [US Food and Drug Administration] should put out some warnings about this particular clinical entity."