Osteoporosis Treatment： When to Discontinue and When to Re-start.pdfVIP

BoneResearch(2013)4：323·335 www．boneresearch．org REVIEW OsteoporosisTreatment：WhentoDiscontinueand WhentoRe—Start SilvanoAdami，LucaIdolazzi，ElenaFracassi，DavideGatti，MaurizioRossini RheumatologyUnit，UniversityofVerona，37126Verona，Italy A numberofeffectivetherapiesforthetreatmentofosteoporosishavebecomeavailablein recentFears． However,uncertainty existsregarding theirlong-term useand effectiveness．Bisph0sphOnate treatment, unlikehormonereplacement,denosumab orteriparatide，isassociatedwith benefitsextended even after treatmentdiscontinuation．Theextendedbenefitsaremostapparentforalendronate(ALN)andzoledronate (ZOL)．A drugholidaymightbeconsideredinpatientsatlow-moderateriskandwhohavebeenfully compliantwith rteatment,andwhohavehadaresponsetorteatment．In patientsatlow—moderaterisk of fracturesthedecision toconsidera drugholiday shouldbebalanced alsowith thesafetyprofileofeach treatm ent． Keywords：osteoporosistreatment；bisphOsphonates；durationofosteoporosistreatment BoneResearchf201314：323—335．doi：10．4248／BR201304003 lntToduction time—frame，which might be considerabIv different amongavailabletherapies． The aim ofosteoporosistreatmentisto preventfragility In thisarticle we willsummarize the available data fractures．Pharmacologicaltreatmentforosteoporosisis concerningtheconsequencesofanti．．reabsorptivetreat．． only indicated when the fracture risk isconsidered mentdiscontInuationandthebenefit／drawbackratioof unacceptablyhigh (1)，suchthattreatmentbenefits discontinuationinrelationshipalsowith longterm safety overwhelminglyexceedtherisks． proifile． Pharmacological treatment should be continued while the fracture