What are the risks and benefits of discontinuing bisphosphonate therapy?

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In postmenopausal women with osteopenia or osteoporosis, discontinuation of zoledronic acid (at 3 years) or alendronate (at 5 years) increases the risk of vertebral fractures, but not nonvertebral fractures (SOR: B, single RCT for each medication). However, women with a femoral neck T-score less than -2.5 after 5 years of alendronate have an increased risk of nonvertebral fracture when alendronate is discontinued (SOR: B, single RCT). Lower hip T-score (-2.3 to -4.2) and older age are associated with increased fracture risk during bisphosphonate holiday (SOR: B, single RCT).

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