Use of Bisphosphonates in Older Adults: How Long Is Long Enough?
Abstract:Objective: To assess the benefits and risks of long-term bisphosphonates for treatment of osteoporosis in older adults. Data Sources: A MEDLINE search was performed using PubMed from 1966 through 2011 to identify relevant publications. Key words searched included: adverse effects (AEs), aged, alendronate, atrial fibrillation, atypical fractures, bisphosphonate-associated osteonecrosis of the jaw, bisphosphonates, diaphyseal fractures, gastrointestinal cancer, ibandronate, musculoskeletal pain, osteoporosis, risedronate, subtrochanteric fractures, and zoledronic acid. Additional sources were obtained through bibliographic review of selected articles. Study Selection: Relevant studies that examined efficacy and safety of bisphosphonates in the treatment of osteoporosis were included. Focus was given to data involving older adults. Stronger levels of evidence (prospective trials) were given preference as the predominant body of literature, when available. Data Synthesis: Osteoporosis affects millions of elderly patients. Bisphosphonates represent first-line therapy. Recent literature has heightened concerns regarding AEs associated with long-term use, leading to the proposition of a "drug holiday." Additionally, there is a lack of literature concerning management of bisphosphonates in older adults. Conclusion: Evidence indicates that bisphosphonates maintain their efficacy and safety in older adults. Consideration must be given on a case-by-case basis to potential AEs associated with long-term use, as well as the derived benefit. Drug holidays may be appropriate given consideration of certain patient characteristics. Well-designed, prospective studies are needed to evaluate long-term use and AEs in older adults; therefore, clinical judgment combined with available evidence will have to suffice as the current practice.
Keywords: AAOMS = American Association of Oral and Maxillofacial Surgeons; AE = Adverse effect; AFib = Atrial fibrillation; Adverse effect; Atypical fracture; BE = Barrett&s esophagus; BMD = Bone mineral density; BONE = The Oral Ibandronate Osteoporosis Vertebral Fracture Trial in North America and Europe; Bisphosphonates; DXA = Dual-energy X-ray absorptiometry; Elderly; FIT = Fracture Intervention Trial; FLEX = Fracture Intervention Trial Long-Term Extension; GPRD = General Practice Research Database; HIP = Hip Intervention Program; HORIZON-PFT = Health Outcomes and Reduced Incidence with Zoledronic Acid One Yearly Pivotal Fracture Trial; HORIZON-RFT = Health Outcomes and Reduced Incidence with Zoledronic Acid One Yearly Recurrent Fracture Trial; IU = International units; ONJ = Osteonecrosis of the jaw; Osteoporosis; QOL = Quality of life; SCI = Spinal cord injury; SSBT = Severely suppressed bone turnover; VA = Veteran&s Affairs; VERT-MN = Vertebral Efficacy with Risedronate Therapy-Multinational
Document Type: Research Article
Publication date: 2013-01-01
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