Bisphosphonate drug holidays: Risk of fractures and mortality in a prospective cohort study.

•This observational study examined fractures and mortality during bisphosphonate (BP) holidays.•We analyzed BP holidays that started within 6 months prior to or during an observation period of up to 25 months.•Major osteoporotic fracture (MOF) risk did not significantly differ overall between BP holidays and ongoing BP use.•However, in the presence of a prevalent vertebral fracture, MOF risk was higher for a time > 12 months than for a time mainly > 6 to ≤ 12 months since the start of a BP holiday.•A prevalent vertebral fracture may increase the relative risk of MOFs associated with a longer BP holiday.