Osteoporosis Monitoring and Drug Holiday

Question 1

Osteoporosis monitoring for efficacy and toxicity

Answer 1

DEXA scan at baseline and every 1-2 years

BTMs- look for reductions after 3-6 months of antiresorptive therapy

Continue to monitor other labs based on medications used

Adherence, adverse drug effects, review risk factors and modifiable lifestyle changes/fall prevention, encourage calcium and vitamin D, accurate height measurement annually

Question 2

Treatment success

Answer 2

Stable or increased BMD with no new fracture or fracture progression, appropriate changes in BTMs

Question 3

Treatment failure

Answer 3

Progression of BMD loss or fractures while on therapy for more than 3-6 months

Question 4

When to consider a drug holiday

Answer 4

After 3 years on BP IV therapy, 5 years on BP PO therapy

High risk patients- 6 years on BP IV therapy, 10 years on BP PO therapy, or using another agent during the BP holiday

Question 5

When to resume BP therapy on a drug holiday

Answer 5

Fracture or significant BMD loss, rise in bone resorption markers to pre-treatment levels