Observational studyMedical care2020
Duration of Bisphosphonate Drug Holidays and Associated Fracture Risk.
Observational study in Medical care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it, 54 citations in OpenAlex.
- Discontinuation of bisphosphonates in seniors: a systematic review on health outcomes.Archives of osteoporosis · 2021Pooled it
- Impact of bisphosphonate drug holidays on bone mineral density and osteoporotic fracture risk: real-world evidence from a retrospective cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Management of postmenopausal osteoporosis.Endocrine reviews · 2026Review
- Clarifying clinically treatment-naive status for osteoporosis patients.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Review
- Shifting bisphosphonate prescribing patterns for fracture prevention: a 24-year national surveillance of men in the U.S. Veterans Health Administration.Archives of osteoporosis · 2026Article
- Comprehensive nursing intervention improves psychological outcomes, sleep quality, pain, and coping in patients with comorbid depression and thoracolumbar compression fracture.Frontiers in psychiatry · 2026Article
- Article
- Postmenopausal Osteoporosis: From Molecular Pathways to Therapeutic Targets-A Mechanism-to-Practice Framework Integrating Pharmacotherapy, Fall Prevention, and Adherence into Patient-Centered Care.Journal of clinical medicine · 2025Review
- The relationship between osteoporosis treatment history and receipt of a second zoledronic acid dose.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Expert Perspective: How, When, and Why to Potentially Stop Antiresorptive Drugs in Osteoporosis.Arthritis & rheumatology (Hoboken, N.J.) · 2025Review
- A comprehensive update on the cost-effectiveness of 10-year denosumab vs alendronate in postmenopausal women with osteoporosis in the United States.Archives of osteoporosis · 2025Article
- Osteoporosis medication use over time in the United States and Canada.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Effects of discontinuing different antiresorptive regimens on medication-related osteonecrosis of the jaw in patients undergoing dental procedures: a systematic review and network meta-analysis.EFORT open reviews · 2025Article
- Atypical Femur Fractures-An Analysis of 69 Patients from 15 Years.Journal of clinical medicine · 2025Article
- Bisphosphonate drug holidays in osteoporosis according to fracture risk profile.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Observational
- Using DEXA to diagnose impending atypical femoral fracture in an asymptomatic patient on long term bisphosphonates: A case report of a missed opportunity for fracture prevention.Clinical case reports · 2024Article
- Effect of Oral Bisphosphonate Drug Holiday on Mortality Following Hip Fracture.The Journal of clinical endocrinology and metabolism · 2024Article
- Asia-Pacific consensus on long-term and sequential therapy for osteoporosis.Osteoporosis and sarcopenia · 2024Review
- Prescriber Perspectives and Experiences with Deprescribing Versus Continuing Bisphosphonates in Older Nursing Home Residents with Dementia.Journal of general internal medicine · 2023Article
- Long-term and sequential treatment for osteoporosis.Nature reviews. Endocrinology · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundDiscontinuation of bisphosphonates (BP) or a "drug holiday" after several years of treatment is increasingly common. However, the association of drug holiday duration with future fracture risk is unclear.
objectivesWe evaluated the rate of fracture in relation to various lengths of drug holidays among women receiving long-term BP therapy. RESEARCH
designObservational cohort study using US Medicare data 2006-2016. Incidence rates (IRs) and Cox proportional hazards models were used to evaluate the rate and adjusted hazard ratios (aHRs) controlling for potential confounders. SUBJECTS: Women aged 65 years and above enrolled in fee-for-service Medicare who had been adherent (≥80%) to alendronate, risedronate, or zoledronate for ≥3 years. MEASURES: Hip, humerus, distal forearm, and clinical vertebral fracture.
resultsAmong 81,427 eligible women observed for a median (interquartile range) of 4.0 (2.5, 5.3) years, 28% of women underwent a drug holiday. In the alendronate cohort (73% overall), the IR of hip fracture among women who discontinued BP for >2 years was 13.2 per 1000 person-years. Risk was increased (aHR=1.3, 1.1-1.4) versus continuing therapy (IR=8.8, referent). Rates were elevated for humerus fracture with discontinuation >2 years (aHR=1.3, 1.1-1.66) and for clinical vertebral fracture with discontinuation >2 years (aHR=1.2, 1.1-1.4). Results were similar for risedronate, zoledronate, and ibandronate for hip and clinical vertebral fracture.
conclusionDiscontinuing alendronate beyond 2 years was associated with increased risk of hip, humerus, and clinical vertebral fractures.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.