A 62-year-old postmenopausal woman with osteoporosis has been on alendronate for 5 years. She is being considered for a 'drug holiday'. According to current evidence, the rationale for a drug holiday after 5 years of bisphosphonate therapy is primarily to reduce the risk of:
- A Atypical subtrochanteric femoral fractures ✓
- B Osteonecrosis of the jaw
- C Esophageal adenocarcinoma
- D Atrial fibrillation
Correct answer: A. Atypical subtrochanteric femoral fractures
Explanation
Long-term bisphosphonate therapy suppresses bone turnover excessively, accumulating microdamage and increasing the risk of atypical subtrochanteric femoral fractures. B drug holiday after 3-5 years in moderate-risk patients allows bone remodeling to resume. Osteonecrosis of the jaw is a real risk but is not the primary reason for drug holiday decisions. Esophageal cancer and atrial fibrillation are not established reasons for drug holidays.
Reference: Harrison's Principles of Internal Medicine, 20th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.