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Bisphosphonates beyond five years

BMJ 2016; 352 doi: (Published 16 March 2016) Cite this as: BMJ 2016;352:i264
  1. Zoe Paskins, clinical lecturer, honorary consultant rheumatologist1 2,
  2. Louise Warburton, senior lecturer in general practice, GP with a special interest in rheumatology and musculoskeletal medicine1
  1. 1Keele University, Staffordshire, ST6 7AG, UK
  2. 2Haywood Rheumatology Centre, Haywood Hospital, Burslem, Stoke-on-Trent, UK
  1. Correspondence to: L Warburton louise.warburton{at}

What you need to know

  • The long term benefit and harm of management to continue or stop bisphosphonates after five years is incompletely understood

  • Offer high risk patients continued prescription, and low risk patients a drug holiday

A 74 year old woman experienced a low impact Colles’ fracture five years ago and was started on a bisphosphonate. At her medication review she discusses for how long she should continue.

What you should cover

Recommendations suggest that bisphosphonate prescription is reviewed at five years.1 2 Explore the patient’s risk factors, tolerance, and adherence. Discuss the benefits, harms, and uncertainties of treatment beyond five years and agree a plan of action.

Re-evaluate the patient’s fracture risk by updating the patient’s history. Revisit the patient’s risk factors for fracture. Check for relevant comorbidities that may have developed since her last review such as rheumatoid arthritis. Review her medication for drugs such as corticosteroids and aromatase inhibitors for breast cancer that increase the risk of fracture.

Have other fractures occurred over the past five years? Explore the possibility of undiagnosed vertebral fracture. A history of thoracic back pain or height loss of more than 4 cm may suggest vertebral …

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