Long-term treatment with bisphosphonates in clinical practice: advantages, main problems and risks

Abstract

Bisphosphonates are the main class of drugs for treatment osteoporosis (OP) and other diseases with increased bone resorption, as bisphosphonates are very effective in reducing risk of fracture. The problem of maintaining the effectiveness and possible loss of effect of bisphosphonates, as well as their safety during long-term use, remains actual Long-them therapy with bisphosphonates and it’s effects has been discussed over the past 20 years, as the risk of osteoporotic fracture may stay hight in patients with presence of irreducible risk factors (continous use of glucocorticoids etc.) despite ongoing antiosteoporotic therapy. Real clinical practice demonstrates very low patient adherence to treatment with bisphosphonates. However, observational studies have showed that treatment with bisphosphonates for more than 10 years without initiating a drug holiday can be effective for patients at high risk of fracture. Moreover, the longer therapy with bisphosphonates is continued and the later the“drug holiday”is initiated, the lower the risks of fractures of the proximal femur and clinical vertebral fractures. However, the duration of continuous bisphosphonate therapy for each patient remains at the decision of the physician and is determined individually in each case, based on the risk-benefit ratio, taking into account the patient’s risk factors for fractures and comorbid diseases.