Duration of Bisphosphonate Treatment for Patients with Osteoporosis: A Review of Clinical Effectiveness and Guidelines


Project Status:
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:


  1. What is the clinical effectiveness of various treatment durations and courses of bisphosphonates for osteoporosis?
  2. What are the evidence based guidelines regarding length of treatment with bisphosphonates for osteoporosis?

Key Message

One relevant health technology assessment and four systematic reviews (including one with meta-analysis) were identified as clinical evidence of various treatment duration and courses of bisphosphonates for osteoporosis.The identified literature were heterogenous and revealed mixed conclusions regarding optimal treatment duration of bisphosphonates for osteoporosis. Incidence of atypical femoral fractures increased with duration of bisphosphonate treatment. Other types of adverse events were generally no different between the various durations of treatment reported, except for one study reporting four deaths (none considered associated with treatment) in their continuation group compared with none in the discontinuation group. No clear direction emerged regarding the effect of treatment duration on bone mineral density or on risks related to other types of fractures (e.g., vertebral, nonvertebral, morphometric).Six evidence-based guidelines were identified regarding the length of treatment with bisphosphonates for osteoporosis. These offer no clear direction on optimal duration of bisphosphonate treatment or drug holidays; however, most guidelines are in concordance that regular patient monitoring and the individualisation of treatment in response to clinical and paraclinical manifestations. The limitations of the included studies, such as the heterogeneity of primary studies included in the systematic reviews and the low-quality evidence upon which guideline recommendations were based, should be considered when interpreting the results.