AJM onlineReviewWestern Osteoporosis Alliance Clinical Practice Series: Evaluating the Balance of Benefits and Risks of Long-Term Osteoporosis Therapies
Section snippets
Why Does Osteoporosis Require Long-Term Treatment?
Osteoporosis is typified by bone loss that weakens the skeleton and predisposes individuals to fracture.8 Osteoporosis therapies decrease the probability of a fracture,9, 10, 11, 12, 13, 14, 15, 16, 17 with many providing rapid protection—within 6-12 months for vertebral fracture18 and within 3 years for nonvertebral or hip fractures.9, 11, 12, 14, 15 No therapy totally eliminates the risk of fracture, in part because of the notable role of trauma.
Antiresorptives such as bisphosphonates and
Possible Loss of Efficacy over Time
Most of the regulatory fracture prevention trials have had difficulty in retaining large numbers of patients for trial extensions. Further, there has been a lack of placebo groups in most studies over 3 years. Because of this, significant fracture endpoints, particularly for nonvertebral fracture, have been difficult to demonstrate over the long term. With long-term use of bisphosphonates there is no incremental fracture risk-reduction beyond that realized in the initial years of therapy.12, 22
Conclusions
There are effective clinical tools for diagnosing osteoporosis, assessing fracture risk, and identifying individuals most likely to benefit from pharmacological therapy to reduce fracture risk. There are many options for pharmacological therapy to reduce fracture risk; however, there remains a significant care gap in patients following fragility fracture.74, 75
All therapies have risks, but in appropriately selected patients, risks of osteoporosis therapy are very low when compared with
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Evaluation of segmental mandibular resection without microvascular reconstruction in patients affected by medication-related osteonecrosis of the jaw: a systematic review
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2021, British Journal of Oral and Maxillofacial SurgeryCitation Excerpt :The term ‘osteonecrosis of the jaws’ (ONJ) refers to a potentially serious complication due to treatment with drugs, such as anti-angiogenic or anti-resorptive agents.1,2
Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment
2019, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyProceedings of the 2017 Santa Fe Bone Symposium: Insights and Emerging Concepts in the Management of Osteoporosis
2018, Journal of Clinical DensitometryCitation Excerpt :This recommendation essentially suggests continuing treatment in patients who still meet the criteria for being on an osteoporosis drug. For the smaller number of patients who do not meet these criteria for being at high risk, interruption of treatment for 1–2 years can be considered (but not mandated) with plans to restart treatment if indications for therapy return (46). The concept of a “drug holiday” clearly does not pertain to patients on other osteoporosis drugs such as denosumab (72).
Funding: This review was funded by the Western Osteoporosis Alliance, a not-for-profit Society registered in British Columbia, Canada.
Conflict of Interest: DLK has received institutional grant/research support from Amgen, Astelis, AstraZenika, and Eli Lilly & Company and he has served on scientific advisory boards and speakers bureaus for Amgen, Merck, Eli Lilly & Company, and Pfizer. KSD has received consulting fees or honorarium from Novartis, Merck and Amgen. LD has served on Speakers' Bureaus for Amgen, Merck, Eli Lilly & Company, Servier and Bayer. DAH has received grant/research support from Amgen, Eli Lilly & Company, Merck, and Novartis, as well as the Canadian Institutes of Health Research, and Pure North S'Energy Foundation. He has served on scientific advisory boards for and received speaking honoraria from Amgen, Merck, and Eli Lilly & Company. STH has provided sponsored presentations for Eli Lilly & Company, Shire and Gilead Sciences and has acted as a consultant to Eli Lilly & Company, Gilead Sciences, Merck, Myovant Sciences and Radius Health. MRM has received consulting fees or honorarium from Amgen and Radius Health. PDM is a member of the Scientific Advisory Boards for Alexion, Amgen, AgNovos, Eli Lilly & Company, Merck, Radius Pharma and Roche and holds research Grants from Amgen, Boehringer Ingelheim, Immunodiagnostics, Eli Lilly & Company, Merck, Merck Serrano, Novartis, Novo Nordisk, Radius Pharma, Roche Diagnostics and Takeda. EML has received institutional grant/research support from Amgen, Merck, and Eli Lilly & Company and he has served on scientific advisory boards for Amgen, Merck, Eli Lilly & Company, Radius Health, Alexion and Shire.
Authorship: All authors had a role in researching and writing this manuscript.