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Inicio Medicina Clínica (English Edition) Therapeutic holidays in osteoporosis: Long-term strategy of treatment with bisph...
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Vol. 146. Issue 1.
Pages 24-29 (January 2016)
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Vol. 146. Issue 1.
Pages 24-29 (January 2016)
Review
Therapeutic holidays in osteoporosis: Long-term strategy of treatment with bisphosphonates
Vacaciones terapéuticas en osteoporosis: estrategia en el tratamiento a largo plazo con bifosfonatos
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María Jesús Moro Álvareza,
Corresponding author
, José Luis Neyrob, Santos Castañedac
a Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain
b Servicio de Ginecología y Obstetricia, Hospital Universitario Cruces, Baracaldo, Vizcaya, Spain
c Servicio de Reumatología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
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Table 1. Recommendations regarding duration and rationale for considering bisphosphonate therapy holidays.
Abstract

Oral bisphosphonates (BFs) are drugs widely used in the treatment of osteoporosis and placed as first-line treatment for osteoporosis in most clinical guidelines. BFs are effective drugs that reduce the incidence of fractures and even reduce mortality. Because of their great affinity for bone, BFs have shown that even when they are discontinued still offer a latent protective effect on bone mineral density, maintaining their anti-fracture effect.

However, prolonged use for years has been linked to the gradual emergence of complications such as osteonecrosis of the jaw or atypical femur fractures, which have raised questions as when to hold and when to make a final or temporary break, recognized as periods of rest or “therapeutic holidays” of these drugs.

Thus, in patients treated with BF for a period of 3–5 years with a low risk of fracture, the drug should be discontinued and restarted when there is an indication for treatment. In contrast, in patients with moderate risk, therapeutic holidays are advised, while reassessing after 2–3 years for restarting purposes. Finally, in patients with high risk of fracture, treatment with BF should not be withdrawn.

Keywords:
Osteoporosis
Bisphosphonates
Antiresorptive treatment
Therapeutic holidays
Resumen

Los bifosfonatos (BF) orales son fármacos ampliamente utilizados en el tratamiento de la osteoporosis y se sitúan como primera línea de tratamiento para la osteoporosis en la mayoría de las guías clínicas. Son fármacos eficaces que reducen la aparición de fracturas e incluso disminuyen la mortalidad. Debido a su gran afinidad por el tejido óseo, los BF han demostrado que, incluso cuando se interrumpe su administración, siguen ofreciendo un efecto protector sobre la densidad mineral ósea e incluso sobre la aparición de nuevas fracturas.

Sin embargo, su uso prolongado durante años se ha relacionado con la aparición de algunas complicaciones, como la osteonecrosis mandibular o las fracturas atípicas de fémur, que han cuestionado la duración del tratamiento con estos fármacos y abierto la posibilidad de realizar interrupciones, definitivas o temporales, reconocidas como «vacaciones terapéuticas».

Así, en pacientes tratados con BF durante un período de 3 a 5 años con riesgo bajo de fractura, se aconseja retirar el fármaco y reiniciarlo cuando vuelva a presentar indicación de tratamiento. En cambio, en pacientes con riesgo moderado, se aconseja realizar vacaciones terapéuticas y reevaluar a los 2-3 años para reiniciar el tratamiento. Por el contrario, en aquellos pacientes con riesgo elevado de fractura no debería retirarse el tratamiento.

Palabras clave:
Osteoporosis
Bifosfonatos
Tratamiento antirresortivo
Vacaciones terapéuticas

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