Evaluation of fracture risk and potential drug holidays for postmenopausal women on long-term bisphosphonate therapy

Study objective: To describe characteristics of postmenopausal women on long-term bisphosphonate therapy who fall into one of four fracture risk categories (low, mild, moderate, high), and to determine the prevalence of women eligible for a drug holiday. Design: Retrospective electronic health record review. Setting: Eight primary care clinics within a university-based health care system. Patients: A total of 201 postmenopausal women of ages 55-89 years, with osteopenia or osteoporosis, prescribed bisphosphonate therapy for > 4 years, between October 10, 2002 and September 9, 2012. Main results: The patients' mean age was 71.4 (+/- 8.2) years; their mean body mass index was 25.3 (+/- 5.6) kg/m(2); and 73.1% were white. Seventy-four out of 201 patients (36.8%) were low-risk; 10/201 (5.0%) were mild-risk; 72/201 (35.8%) were moderate-risk; and 45/201 (22.4%) were high-risk. Eighty-one women (40.3%) were eligible for a drug holiday or discontinuation. The estimated drug cost avoided per eligible patient was $574.80. Calcium and/or vitamin D supplementation was documented in 52.7% of women. Conclusion: More than one-third of postmenopausal women taking long-term bisphosphonate therapy had low fracture risk, and over 40% of our patients were eligible for a drug holiday or discontinuation. These data emphasize the need to accurately assess risk and benefit in patients treated with bisphosphonate therapy.