You may need a temporary pause or break from osteoporosis treatment, especially if you take medications called bisphosphonates. These medicines protect your bones and help your body lose less bone over time.
Doctors call this pause a “drug holiday.” They recommend it to help you avoid side effects that can occur when taking bisphosphonates for too long.
If you have osteoporosis, bisphosphonates help prevent fractures. They can lower your risk of spine fractures by up to 70%, other bone fractures by 40%, and hip fractures by 50%.
“There are some very rare side effects linked to bisphosphonates. The risk is quite low, but it increases with prolonged and uninterrupted treatment,” says Elaine Yu, MD, director of the Bone Density Center at Massachusetts General Hospital.
“To lower that risk, we recommend that patients consider taking a medication pause.”
The FDA suggests that pausing treatment may not be a good idea if you are at high risk for fractures. These medications go a long way toward protecting your bones, and the side effects are usually minimal.
What Are the Possible Side Effects?
Bisphosphonates and other osteoporosis treatments can cause side effects such as nausea or dizziness, but they are usually mild and manageable. Still, if you take them for a long time, there is a small risk that they may cause more serious side effects.
Here are some you should know:
Osteonecrosis of the jaw (ONJ). It is a rare but serious condition that causes the death of bone cells in the jaw. It can cause damaged (necrotic) bone in the jaw to project outside the gum.
Symptoms:
- Pain in the jaw
- Loose teeth
- Mouth sores
- Pus-like discharge from gums and mouth
- Swollen gums
Atypical femur fracture (AFF). A type of stress fracture that usually appears in the upper part of the thigh bone. Diagnosis includes X-rays of both thighs, as fractures can occur on both sides. The main symptom is pain in the upper thigh and hip without a history of injury.
Discomfort in the esophagus. It is unclear whether bisphosphonates increase the risk of esophageal cancer. Studies suggest that this possible relationship is not necessarily due to treatment, but rather to other factors such as age or certain health conditions. Symptoms include pain or burning when swallowing.
Do You Qualify for a Bisphosphonate Break?
If you have osteoporosis and take bisphosphonates, your doctor may let you take a break if you have any of these conditions:
- You have been taking the medication for a long time (two years or more).
- You have jaw pain.
- You have loose teeth or sores in your mouth.
- You have swollen gums.
- You have permanent thigh pain.
But if the medication is working and you don’t have any side effects, your doctor will likely recommend continuing the treatment.
How to Monitor Your Osteoporosis During a Medication Break
If your doctor recommends a break from osteoporosis medications, don’t worry.
“The good thing about bisphosphonates is that fracture prevention doesn’t go away immediately. The benefits can last one to two years after stopping the medication,” says Yu.
As a result, you may want to consider taking a break while those benefits are still working and minimizing side effects.
What to expect during the break:
- Your doctor may order a bone densitometry (DXA) test every two years to measure your bone density.
- You may also get blood tests to see if there’s an increase in the chemicals released when bone begins to weaken.
It’s Not Safe to Pause Treatment on Your Own
The decision to take or stop taking medication is yours, but it’s important to talk to your doctor about the risks and benefits. For osteoporosis, the benefits often outweigh the risks.
“You must weigh the risk of fracture against your concerns about possible atypical side effects. When you stop taking medications, the risk of side effects decreases, but the risk of fracture increases,” Yu says.
Show Sources
Photo Credit: Tetra Images/Getty Images
SOURCES:
Elaine Yu, MD, director, Bone Density Center, Massachusetts General Hospital.
International Osteoporosis Foundation: “Bisphosphonates.”
FDA: “FDA Drug Safety Communication: Ongoing safety review of oral bisphosphonates and atypical subtrochanteric femur fractures.”
ClevelandClinic.org: “Osteonecrosis of the Jaw (ONJ).”
PennStateHealth.org: “Bisphosphonate-related Atypical Femur Fractures: Detection and Management.”
Endocrine Reviews: “Atypical Femur Fractures: Review of Epidemiology, Relationship to Bisphosphonates, Prevention, and Clinical Management.”
Sage Journals: “Bisphosphonate drug holiday: who, when and how long.”
Harvard Health Publishing: “For women on osteoporosis drug 'holiday’, bone testing at one year offers little benefit.”
British Pharmacological Society Journals: “Side effects of drugs for osteoporosis and metastatic bone disease.”
