The Swiss Association against Osteoporosis has published a position statement on the duration and the management of osteoporosis drug treatment after discontinuation, focusing on the long-term management of osteoporosis therapy in patients with fragility fractures and in patients considered to be at high fracture risk on the basis of clinical risk factors and/or low bone mineral density (BMD) . Most patients start with an antiresorptive treatment, i.e. drugs that inhibit osteoclast development and/or function (estrogens, selective estrogen receptor modulators, bisphosphonates, denosumab). In the balance between benefits and risks of antiresorptive treatment, uncertainties remain regarding the optimal treatment duration and the management of patients after drug discontinuation.
A patient is considered to remain at high risk of fracture if any of the following conditions is present: (1) hip, spine or multiple osteoporotic fractures within 5 years before and/or during therapy; (2) high fracture risk score at baseline according to FRAX and/or continuously high fracture risk based on clinical judgment or co-morbidities (e.g. continuous use of aromatase inhibitors for breast cancer, diabetes, frailty); (3) persistent low BMD. Those with a T-score persistently lower than ˗2.5 SD at the femoral neck or <˗2.0 SD in older patients and/or frequent fallers) benefit the most from continuing therapy . Regular reassessment of fracture risk for decision of treatment duration is essential.
Professor Emeritus for Gynaecological Endocrinology and Reproductive Medicine, University of Berne, Switzerland