Patient Information - Staying on Bisphosphonate Treatment After 5 Years

If you have been prescribed a bisphosphonate medicine (such as alendronic acid, risedronate or zoledronic acid) to strengthen your bones and reduce the risk of fractures, the current national guidance (NICE and the National Osteoporosis Guideline Group) recommends that these medicines are reviewed after:

• 5 years for tablet treatments (e.g. alendronic acid, risedronate)
• 3 years for intravenous zoledronic acid
  

This review helps decide whether you should continue treatment or take a planned “treatment pause”.

Why is treatment reviewed?

Bisphosphonates remain in the bones for a long time, even after stopping the medication. This means their protective effect often continues for several years after treatment is paused.

These medicines are very effective at preventing fractures, especially of the hip and spine. However, using them for many years may slightly increase the risk of rare side effects.

Possible rare risks with long-term treatment

These side effects are uncommon but are considered when reviewing long-term treatment:

• Atypical femoral fractures: rare stress-type fractures of the thigh bone
• Osteonecrosis of the jaw (ONJ): delayed healing of the jaw bone, usually after major dental work such as tooth extraction
  

These risks are very small, but reviewing treatment ensures the benefits continue to outweigh any potential harms.

Who may benefit from continuing treatment?

Some patients are advised to stay on treatment longer than 5 years if their fracture risk remains high. This may include people who:

• Are older (especially over 75)
• Have previously had a hip or spinal fracture
• Have ongoing steroid treatment
• Have very low bone density or high fracture risk scores

What is a “treatment pause”?

If your fracture risk is now lower, we may suggest a planned pause in treatment (sometimes called a “drug holiday”).

This means:

• You stop taking the medication for a period (often 2–3 years)
• Your bones remain protected by the medication already stored in them
• We monitor your bone health and reassess your fracture risk later

Your medication review

We would like to review your bone health and discuss whether continuing or pausing treatment is best for you.

During the review we will:

1. Assess your fracture risk (FRAX score)
2. Review any new medical conditions or medicines
3. Consider whether to continue or pause treatment
4. Ensure your calcium and vitamin D intake is appropriate

Please contact the surgery to book a medication review with a GP or Clinical Pharmacist.