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Bisphosphonate duration reassessment — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Bisphosphonate duration reassessmentUSMLE Step 3

A 66-year-old woman with osteoporosis has been taking alendronate for 6 years. She has no fractures, no glucocorticoid use, and current DXA T-score is -2.3 at the femoral neck. FRAX hip fracture risk is 2.1%. She asks whether to continue. Which of the following is the most appropriate at this time?

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Correct answer: B — Consider a bisphosphonate holiday with periodic reassessment

After 5 years of oral bisphosphonate therapy, patients at low-to-moderate fracture risk can be considered for a drug holiday with periodic reassessment. High-risk patients generally continue therapy.

Reference: Endocrine Society Osteoporosis Guideline