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How long should you take bisphosphonates for osteoporosis?

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Long-term use of bisphosphonates for osteoporosis may not prevent fractures, according to a new study.

Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. According to the UK’s National Osteoporosis Society, one in two women and one in five men over the age of 50 will break a bone as a result of osteoporosis.

Bisphosphonates are one of the treatments available. These drugs slow down the rate at which bone is broken down in your body, maintaining bone density.

Studies have confirmed that that the risk of bone fractures is reduced when women with low bone mineral density take bisphosphonates for between one and four years. However, little is known about whether taking them for longer has the same effect.

Now, research published in the Journal of the American Geriatrics Society has looked at whether older women taking bisphosphonates for 10-13 years had fewer bone fractures than older women with similar fracture risks who took these medicines for a shorter period.

The research team used the Women’s Health Initiative study, a large study that began in 1993 to develop ways to reduce heart disease, cancer and fractures in women after menopause. They focused on 5,120 women who were bisphosphonate users with a high risk for bone fractures.

When the study started, 13% had been taking bisphosphonates for two years, 34% for three to five years, 20% for six to nine years and 33% for 10-13 years.

The researchers followed the women in the study for nearly four years. They discovered that women who took bisphosphonates for 10-13 years had higher fracture rates, compared with women who took the medication for two years. Taking bisphosphonates for three to nine years was not linked to a higher fracture risk.

“Our study and several others have found higher risk of fractures among very long-term bisphosphonate users, compared with short-term users,” said Rebecca L. Drieling, one of the study authors. “However, the ideal length of bisphosphonate use has not yet been studied in randomised clinical trials, which are considered the gold standard of research studies. Therefore, long-term bisphosphonate users should see their healthcare providers regularly to decide how long to continue bisphosphonate therapy in their individual cases.”