| Popis: |
Bisphosphonate therapy is now the mainstay of treatment for patients with primary and secondary forms of osteoporosis. This class of drugs has earned this role because of multiple studies documenting the reduction in the incidence of vertebral and other fragility fractures in older women with osteoporosis at moderate to high fracture risk and the prevention of bone loss in many other medical conditions with bisphosphonate therapy (1). After beginning therapy, clinicians then confront the question of how long therapy should be continued. Unless there are obvious safety issues, long-term therapy is generally planned for chronic degenerative disorders such as osteoporosis. Such therapy with bisphosphonates poses unique challenges. The drugs accumulate in the skeleton, theoretical concerns about the safety of long-term treatment with potent inhibitors of bone remodeling exist, and there are suggestions that significant clinical benefit persists well beyond the treatment interval (2-4). Needed is a study in which important clinical outcomes are assessed in patients who have been on bisphosphonate therapy for several years and who then either continue or discontinue treatment. The recent FLEX study by Black and colleagues provides much of that information and is the most comprehensive set of data we have to determine whether there is value or harm in continuing alendronate therapy beyond 3-6 years (5). Even with these results, there will be debate about the need for and safety of long-term bisphosphonate treatment. |
