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Guidelines for osteoporosis medications call for a 'drug holiday': for women who do not have a high fracture risk, a break from bisphosphonate drugs is advised.

Bisphosphonate drugs are medications designed to treat osteoporosis by increasing bone density. The first bisphosphonate was approved by the US Food and Drug Administration in 1995. However, ongoing safety reviews have revealed concerns about effects from long-term bisphosphonate use, which have been linked with a small (less than one percent) risk of osteonecrosis (bone death) of the jaw and atypical fractures of the femur (fractures that occur in the thigh bone just below the hip joint or in the long part of the bone). Labels on bisphosphonate drugs have carried warnings about these conditions for years.

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In January 2016, a task force of the American Society for Bone and Mineral Research released guidelines on the optimal duration of bisphosphonate therapy in patients with osteoporosis.

"The most important take-home message from the recent guidelines on bisphosphonate therapy is that, for women treated with bisphosphonates, a 'drug holiday'--that is, stopping the medication for two to three years--should be considered following five years of oral or three years of intravenous bisphosphonate use, depending on the patient's response to treatment," explains Jason Baker, MD, an endocrinologist at Weill Cornell Medicine and New York-Presbyterian Hospital.

A Closer Look at the Guidelines

The guidelines emphasize the need for reassessment of fracture risks on a regular basis for all women being treated with bisphosphonates for osteoporosis. For each woman and her doctor, the goal is to determine how to maximize the benefits of taking a bisphosphonate while minimizing the potential risks.

"Factors that a woman and her doctor need to consider when making decisions about osteoporosis medications include the severity of the osteoporosis, its underlying cause(s), the side effect profiles of medications, and cost," says Dr. Baker.

The guidelines also state that, for patients at high risk of fractures, the reduced risk of vertebral fractures associated with bisphosphonate use outweighs the risk of osteonecrosis or atypical femoral fractures.

Lifestyle for Strong Bones

Given the concerns about the risks associated with bisphosphonate use, it's crucial that women carefully consider other ways to protect their bones. Fortunately, several lifestyle choices can have a significant impact on bone health.

"Lifestyle factors that can help maintain and/or strengthen bones include adequate dietary calcium and vitamin D intake, good exercise habits with inclusion of weight-bearing exercises, smoking cessation, and avoidance of excessive alcohol intake," says Dr. Baker.

Calcium-rich foods include yogurt and milk. Leafy greens, sardines, soybeans, and white beans are non-dairy sources of calcium, and orange juice, soymilk and other plant-based beverages, and breakfast cereals are often fortified with calcium. Fatty fish, including salmon, tuna, and mackerel, eggs, and mushrooms treated with ultraviolet light contain naturally occurring vitamin D, and milk, juices, and cereals are often fortified.

Osteoporosis Screening

An imaging test called a dual energy x-ray absorptiometry scan, or DEXA scan, calculates a number that represents bone mineral density (BMD) called a T score.

"Women at average risk of osteoporosis should have a DEXA scan at age 65, while women who have an increased risk should have a scan at a younger age," advises Dr. Baker.

Your T score indicates if your bone density is normal, or if you have osteopenia (reduced bone mass) or osteoporosis (brittle, fragile bones):

* Normal BMD: -1.00 or higher

* Osteopenia: -1.01 to -2.49

* Osteoporosis: -2.50 or lower

Dr. Baker recommends having a repeat DEXA scan one to two years after initiating treatment for osteoporosis, and, thereafter, every one to two years as warranted per treatment response.

WHAT YOU SHOULD KNOW

Risk factors for osteoporosis include:

* A family history of osteoporosis

* A personal history of prior nontraumatic fracture

* Being a postmenopausal woman

* Having a small body frame

* Being of Caucasian or Asian ethnicity

* Long-term oral or injected steroid use

* Smoking

* Thyroid and parathyroid disorders

* Celiac disease and inflammatory bowel disease
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Title Annotation:MEDICATION
Publication:Women's Health Advisor
Date:Sep 1, 2016
Words:632
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