PMID- 23315281
OWN - NLM
STAT- MEDLINE
DCOM- 20130409
LR  - 20130114
IS  - 0888-5109 (Print)
IS  - 0888-5109 (Linking)
VI  - 28
IP  - 1
DP  - 2013 Jan
TI  - Use of bisphosphonates in older adults: how long is long enough?
PG  - 39-57
LID - 10.4140/TCP.n.2013.39 [doi]
AB  - OBJECTIVE: To assess the benefits and risks of long-term bisphosphonates for 
      treatment of osteoporosis in older adults. DATA SOURCES: A MEDLINE search was 
      performed using PubMed from 1966 through 2011 to identify relevant publications. 
      Key words searched included: adverse effects (AEs), aged, alendronate, atrial 
      fibrillation, atypical fractures, bisphosphonate-associated osteonecrosis of the 
      jaw, bisphosphonates, diaphyseal fractures, gastrointestinal cancer, ibandronate, 
      musculoskeletal pain, osteoporosis, risedronate, subtrochanteric fractures, and 
      zoledronic acid. Additional sources were obtained through bibliographic review of 
      selected articles. STUDY SELECTION: Relevant studies that examined efficacy and 
      safety of bisphosphonates in the treatment of osteoporosis were included. Focus 
      was given to data involving older adults. Stronger levels of evidence 
      (prospective trials) were given preference as the predominant body of literature, 
      when available. DATA SYNTHESIS: Osteoporosis affects millions of elderly 
      patients. Bisphosphonates represent first-line therapy. Recent literature has 
      heightened concerns regarding AEs associated with long-term use, leading to the 
      proposition of a "drug holiday." Additionally, there is a lack of literature 
      concerning management of bisphosphonates in older adults. CONCLUSION: Evidence 
      indicates that bisphosphonates maintain their efficacy and safety in older 
      adults. Consideration must be given on a case-by-case basis to potential AEs 
      associated with long-term use, as well as the derived benefit. Drug holidays may 
      be appropriate given consideration of certain patient characteristics. 
      Well-designed, prospective studies are needed to evaluate long-term use and AEs 
      in older adults; therefore, clinical judgment combined with available evidence 
      will have to suffice as the current practice.
FAU - Dunn, Rebecca L
AU  - Dunn RL
AD  - Department of Pharmacy, Clinical and Administrative Sciences, University of 
      Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, Oklahoma 
      73117, USA. Rebecca-Dunn@ouhsc.edu
FAU - Bird, Matthew L
AU  - Bird ML
FAU - Conway, Susan E
AU  - Conway SE
FAU - Stratton, Mark A
AU  - Stratton MA
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Consult Pharm
JT  - The Consultant pharmacist : the journal of the American Society of Consultant 
      Pharmacists
JID - 9013983
RN  - 0 (Diphosphonates)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Atrial Fibrillation/chemically induced
MH  - Bisphosphonate-Associated Osteonecrosis of the Jaw/etiology
MH  - Diphosphonates/adverse effects/*therapeutic use
MH  - Femoral Fractures/prevention & control
MH  - Gastrointestinal Neoplasms/chemically induced
MH  - Humans
MH  - Osteoporosis/*drug therapy
MH  - Time Factors
EDAT- 2013/01/15 06:00
MHDA- 2013/04/10 06:00
CRDT- 2013/01/15 06:00
PHST- 2013/01/15 06:00 [entrez]
PHST- 2013/01/15 06:00 [pubmed]
PHST- 2013/04/10 06:00 [medline]
AID - 2W1038035M382421 [pii]
AID - 10.4140/TCP.n.2013.39 [doi]
PST - ppublish
SO  - Consult Pharm. 2013 Jan;28(1):39-57. doi: 10.4140/TCP.n.2013.39.