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Patients Muscles / Skeleton / Joints

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Carenity Member • Community manager
Posted on
Good advisor

Patients who take osteoporosis drugs for long periods typically are advised to temporarily discontinue the drugs to prevent rare but serious side effects to the jaw and thighs.

A Loyola Medicine study has found that 15.4 percent of patients who take so-called "drug holidays" from osteoporosis drugs called bisphosphonates experienced bone fractures. During a six-year follow-up period, the yearly incidence of fractures ranged from 3.7 percent to 9.9 percent, with the most fractures occurring during the fourth and fifth years.

The study by senior author Pauline Camacho, MD, and colleagues was published in the journal Endocrine Practice.

Patients at high risk of fracture who take drug holidays should be closely followed, especially as the drug holiday lengthens, researchers wrote.

Bisphosphonates are the most common medications prescribed for osteoporosis. The drugs slow down the breakdown of bones, helping to maintain bone density and reduce the risk of fractures.

Bisphosphonates have been linked to osteonecrosis of the jaw (ONJ) and atypical femur fracture. ONJ occurs when the jawbone is exposed, typically following a dental procedure, and begins to weaken and die. An atypical femur fracture is an unusual fracture of the thigh bone that can occur even with normal weight bearing.

To reduce the risk of these side effects, the American Association of Clinical Endocrinologists and American College of Endocrinology recommend that women at moderate risk for osteoporosis take a drug holiday after five years of oral and three years of intravenous bisphosphonate treatment. Women at higher risk for osteoporosis should take a drug holiday after 10 years of oral and six years of intravenous bisphosphonate treatment.

However, there is minimal data on how long drug holidays should last. The Loyola study was designed to further characterize the increased fracture risk in patients taking drug holidays. The retrospective study examined the records of 371 women and 30 men with osteoporosis or osteopenia who began drug holidays. (Patients with osteopenia have weak bones, but not yet osteoporosis.) The patients had taken bisphosphonates for an average of 6.3 years before beginning drug holidays. The two most frequently prescribed bisphosphonates were alendronate (Fosamax®), taken by 62 percent of patients, and risedronate (Actonel®), taken by 34 percent of patients.

Sixty-two patients (15.4 percent) experienced fractures after going on drug holidays. The most common sites were the wrist, foot, ribs and spine. (Foot fractures are not currently considered osteoporotic fractures.) Those most likely to experience fractures were older and had lower bone mineral density at the beginning of the study. Following fractures, patients were put back on bisphosphonates.

Drug holidays need further assessment, Dr. Camacho and colleagues wrote. "Patients who begin drug holidays at high risk for fracture based on bone mineral density, age or other clinical risk factors warrant close follow-up during the holiday, especially as its duration lengthens. Fracture risk needs to be regularly assessed during the drug holiday and treatment resumed accordingly."


Science Daily

Beginning of the discussion - 5/14/18

Fifteen percent of osteoporosis patients who take 'drug holidays' suffer bone fractures
Carenity Member
Posted on

Another interesting and knowledgeable article, giving vital information to all with Osteoporosis!

Thank you! 

Fifteen percent of osteoporosis patients who take 'drug holidays' suffer bone fractures
Carenity Member
Posted on

I took arcoxia for a few years but then I became ill after having severe sickness and diarrhoea, resulting in me unable to eat or drink for 3-4 days. I was rushed into hospital with total dehydration which had damaged my kidneys. My inflammation markers were off the roof. I was so unwell that a Dr stayed with me monitoring an ECG as my heart function could be affected but more pressing was the need to get fluids into me quickly. This had to be done aggressively using a large syringe. Thankfully I was in and out of consciousness and slept for long periods so I was unaware of the procedure. I thankfully woke the next day as it had been touch and go if I would even survive the night. I was then on a constant drip of fluids and electrolytes, vitamins etc for 12 days. They contacted to be very concerned that my inflammation markers were still very high and hadn’t improved at all. I had a number of tests and eventually they discovered that I had masses of ulcers throughout my gut even into my stomach lining. Initially they thought I had ulcerative colitis or chrons as there were so many ulcers so biopsies were taken. Finally they discovered that the ulcers were caused by the drug arcoxia. Apparently I must of had the ulcers developing over many months but the strong painkillers I’m on must of masked the pain. Now I’m never to take any medication with anti inflammation drugs including gels and creams. I was shocked that after using a drug for a number of years this could be the outcome. Apparently Arcoxia is one of the newer second generation anti inflammatory drugs that had less risk of this happening than the 1st generation drugs. I had no idea this could happen as it is very rare. Please be careful when using drugs long term. 

Fifteen percent of osteoporosis patients who take 'drug holidays' suffer bone fractures
Carenity Member
Posted on

I have just been diagnosed with the 1st stage of osteoporosis. I have to have a blood test next month. That's as far as l've got at the moment. No information given to me yet.

Fifteen percent of osteoporosis patients who take 'drug holidays' suffer bone fractures
Carenity Member
Posted on

@Hidden username‍ ... Hope they find something from the result of your blood test next month... Keep us posted as to what happens. 

Fifteen percent of osteoporosis patients who take 'drug holidays' suffer bone fractures
Carenity Member
Posted on

good luck Lindyhop with your blood tests, I have osteoporosis, but I carry on doing things ive always done to a point, so if you have got it don't do like some people I know they wont go out in case they fall never do anything, in case they hurt themselves, I am not saying there wrong I just saying, do what you can, I cant sit around doing nothing I like to keep busy. be careful is my point, but please let us know how you get on good luck x

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