Impact of a bisphosphonate drug holiday on the bone mineral density in patients with osteoporosis at Charlotte Maxeke Johannesburg academic hospital from 2000-2016

Rukarwa, Rutendo
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Background: Bisphosphonate therapy has efficacy in the management of osteoporosis. Rare adverse effects related to its prolonged use has resulted in the concept of a “drug holiday” (DH). Objective: To evaluate the effect of a bisphosphonate DH on bone mineral density (BMD). Methods: A retrospective cohort study of 97 patients with osteoporosis who had undertaken a DH was conducted. Results: The median age at the initiation of bisphosphonate therapy was 63 years. The median duration of the DH was 2 years. The overall effect of the DH on BMD as a percentage change from the beginning to the end of the DH showed a decrease in BMD at the lumbar spine [-3.3%, p=0.398]; radius and ulnar [-16.7%, p=0.03] and total hip [-8.9%, p=0.001]. 4 patients sustained fractures during the DH. Conclusion: An individualised approach is key in assessing the duration of the DH and only low risk patients should be considered.
A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine Johannesburg, 2019