Long-Term Safety Of Bisphosphonates

Bisphosphonates are currently the most commonly used drugs in metabolic bone disease, especially in osteoporosis, and efficacy is well documented in studies. The aim of this review, based on existing studies, is to summarize the positive and negative aspects of a long-term therapy with bisphosphonates. Bisphosphonates in osteoporosis lead to a reduction in bone mineral loss and a reduction in fracture risk at the spine, hip and other nonvertebral sites. In addition to the known short-term side effects (irritation oft the esophagus, acute-phase reactions or renal toxicity), potential safety risks and adverse events have been identified in long-term bisphosphonate therapy. These very rare long-term side effects include: osteonecrosis of the jaw, atypical femur fracture, muscle and skeletal pain, atrial fibrillation and esophageal cancer. In some cases, there was no clear causality but there is evidence for an increased, albeit very rare, occurrence. However, an awareness of these adverse events is required. For guideline-appropriate indication and adequate prophylaxis, e.g. in the case of possible necrosis of the jaw, in most patients the benefits of bisphosphonate therapy outweigh the potential risks. Since bisphosphonates have a longer residence time in the bone, taking into account the individual fracture risk after 3-5 years of treatment, a therapy break of 2-3 years (drug holiday) is possible to reduce the long-term risks.