Bisphosphonate Duration — SCE Rheumatology MCQ

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ModerateMetabolic Bone DiseaseBisphosphonate DurationSCE Rheumatology

A 67-year-old woman starts oral alendronate for postmenopausal osteoporosis. She has no previous hip or vertebral fracture and is not taking systemic glucocorticoids. When treatment is initiated, after what duration should a formal review of the need to continue oral bisphosphonate therapy normally be planned?

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Correct answer: E — 5 years

The correct answer is E: 5 years. UK guidance recommends planning oral bisphosphonate treatment for 5 years before formally reviewing the need for continued therapy. This review is not an automatic drug holiday: adherence, incident fractures, BMD and current fracture risk should be reassessed, and treatment continued when risk remains high. Three years is the corresponding review point for intravenous zoledronic acid, not oral alendronate. Ten years may be appropriate as an extended treatment duration in selected patients with persistently high fracture risk, but it is not the routine first review point. One year is too early, while indefinite treatment without review is inappropriate because the balance of benefit and rare long-term harms changes over time.

Reference: National Institute for Health and Care Excellence. Osteoporosis (QS149), Quality statement 4: Long-term follow-up. 2017. https://www.nice.org.uk/guidance/qs149/chapter/quality-statement-4-long-term-follow-up