Drug holiday refers to stopping your osteoporosis medicine for a temporary time period. Essentially you are on “holiday” from taking your medicine. Specifically, this is referring to the bisphosphonate class of medicines.
Expert Opinion
This practice has arisen based on primarily expert opinion since there is scant clinical trials research to provide evidence in this area. In one clinical trial of 10 years duration with Fosamax, the rate of fractures for those on Fosamax for 10 years was similar to those who had stopped their medicines after 5 years of use. In addition, once your bone density increases above the osteoporosis threshold your fracture risk is decreased.
Worry about Side Effects with Long-term Use
Emergence of side effects associated with the longer use of bisphosphonates also adds in to weighing the risk and benefits of continued use of these medicines. Higher risk for unusual fractures of the thigh bone, atypical femur fractures, is observed after five years of use.
When to Restart?
If you stop your bisphosphonate medicine, it may take one to three years on average for your bone breakdown to rev up to untreated levels. The other question is “when do you restart a medicine?” Unfortunately, no data or guidelines are available to answer this. Your doctor may periodically check a bone turnover marker to see if your bone breakdown rate has increased that might signal time to restart treatment.
Discuss Options with Your Doctor
Discuss with your doctor different options if you taken any bisphosphonate for over five years. If you are still in the osteoporosis range by DXA scan or have other risk factors that put you in the high-risk category, you may want to select another osteoporosis medicine to change to rather than taking a complete holiday.
This area is controversial. The dialogues and debates are ongoing among experts and practitioners. Stay tuned!