Optimum duration and safety of long-term use of potent anti-resorptive medications in osteoporosis

Introduction: Anti-resorptive drugs are the most commonly used medications for treating metabolic bone diseases. These agents reduce the risk of osteoporosis fractures, control Paget's disease, hypercalcemia of malignancy and bone metastasis. However, administration of high doses or long-term use are associated with rare but serious adverse effects. Areas covered: Beyond 5 years of use, fracture reduction benefits of bisphosphonate and denosumab are minimal, while the incidence of serious adverse events increases. Thus the FDA recommends limiting treatment to less than 5 years. However, treating beyond 5 years with bisphosphonates or denosumab is appropriate in patients in whom the reduction of fracture benefits outweighs adverse effects. Detailed insight into safety and the duration of use of potent anti-resorptive agents are discussed. Expert commentary: Considering the safety and effectiveness, in patients with osteoporosis and Paget's disease of bone, the use of potent antiresorptive agents should be limited for five years and three years in patients with cancer to control the complications. An annual reassessment is recommended for patients with osteoporosis, and Paget's disease these agents to (a) assess overall health, adherence to medication, and objective measures of improvements; (b) exclude secondary causes of bone loss; and (c) assess the need for continuation of receiving anti-resorptive therapy.