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Bisphosphonate duration review — SCE Geriatric Medicine MCQ

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ModeratePolypharmacyBisphosphonate duration reviewSCE Geriatric Medicine

An 86-year-old woman with severe frailty is reviewed after a fall. She takes alendronate, calcium/vitamin D, atorvastatin, amlodipine and lansoprazole. She has taken alendronate for eight years, has no fractures during treatment and current DXA shows T-score -2.1 at the hip. What is the most appropriate management?

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Correct answer: B — Review bisphosphonate duration and consider a drug holiday if fracture risk is now lower

Long-term bisphosphonate therapy should be reviewed because rare adverse effects rise with prolonged exposure and some patients can pause treatment if fracture risk is no longer high. The decision depends on current fracture risk, prior fractures, age and BMD. Dose escalation is not indicated. The pearl is that deprescribing also applies to preventive medicines that were appropriate when started.

Reference: NOGG 2024; NICE CG146; BNF