- With Mayo Clinic internist
Sandhya Pruthi, M.D.
read biographyclose windowBiography of
Sandhya Pruthi, M.D.
Sandhya Pruthi, M.D.
Dr. Sandhya Pruthi, certified by the American Board of Family Practice, has been practicing medicine at Mayo Clinic since 1995 with special interests in breast diseases and women's health.
She is a consultant in the Department of Internal Medicine, Division of General Internal Medicine, and the Breast Diagnostic Clinic. She is an assistant professor of medicine at Mayo Clinic College of Medicine in Rochester, Minn.
The Winnipeg, Manitoba, native stresses education and patient-related research and has been active in both areas since joining Mayo Clinic. She is the primary investigator at Mayo Clinic of several clinical trials evaluating new agents for the prevention of breast cancer and identification of biomarkers for early detection of breast cancer. Her other research and clinical interests include managing the health of women who are at increased risk of breast cancer, breast pain and hot flashes, and developing patient education decision-making tools for breast-related concerns. She is director of the Breast Diagnostic Clinic and is a member of the Women's Health Executive Committee. Dr. Pruthi has been newly elected as a member to the board of directors for the American Society of Breast Disease. She has assisted with a variety of articles for MayoClinic.com.
"Having an opportunity to share information with my patients in the way that will help them to understand and be able to make educated decisions about their own health is very important to me," she says.
"The Web has become a major information site for people, and I want them to get the best and accurate information to be able to make informed choices for themselves, their family members and friends."
Risk factors (1)
- High-protein diets: Are they safe?
Treatments and drugs (3)
- Osteoporosis medications: Must they be taken indefinitely?
- Osteoporosis and long-term prednisone use: Is there a connection?
- Fosamax and osteonecrosis: Is there a link?
Prevention (4)
- Calcium supplements: Which type is best?
- Chocolate: Does it impair calcium absorption?
- Calcium supplements: Should they be taken with meals?
- see all in Prevention
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Question
Osteoporosis medications: Must they be taken indefinitely?
How long must I take bisphosphonates for osteoporosis? Are osteoporosis medications a lifelong commitment, or can I stop taking them if my bone density improves?
Answer
from Sandhya Pruthi, M.D.
Whether you must take osteoporosis medications for life depends on the type of medication and your individual circumstances. The benefits of osteoporosis medications such as estrogen (Premarin, others), calcitonin-salmon (Miacalcin) and raloxifene (Evista) cease when the medication is discontinued. Other osteoporosis medications — including the bisphosphonates ibandronate (Boniva), alendronate (Fosamax), risedronate (Actonel) and zoledronic acid (Reclast) — may need to be taken indefinitely, too, but that's not always the case.
To determine whether you need lifelong bisphosphonate therapy, your doctor will likely consider three primary factors:
- What's your risk of an osteoporosis-related fracture? In 2008, the National Osteoporosis Foundation issued new guidelines for assessing fracture risk and determining candidates for drug therapy. If you've had an osteoporosis-related fracture, you're considered at high risk of future fractures — and a good candidate for continuing drug therapy. You might consider stopping bisphosphonate therapy, however, if your fracture risk isn't as high as previously thought.
- Will the medication continue to prevent bone loss after you stop taking it? To varying degrees, bisphosphonates help prevent bone loss even after they're discontinued. A key study published in 2006 showed that alendronate still had some effect up to five years after the medication was discontinued. Researchers suggest that it might be appropriate to stop therapy for up to five years if you've taken the medication for five years or longer, you have a low risk of fractures and you're not losing bone density. Although less information is available about other bisphosphonates, the 2006 study raises the question of how much and how long one needs to take these medications to get the desired effect — especially when the risk of fractures is relatively low.
- What's your risk of an adverse effect of long-term bisphosphonate therapy? Rarely, bisphosphonate therapy can lead to osteonecrosis of the jaw — a bone disease that causes pain, swelling or infection in the jaw. You might consider stopping bisphosphonate therapy if you've taken the medication for five years or longer, you have a low risk of fractures or you have active dental disease.
Remember, the decision to continue or stop bisphosphonate therapy is individualized. Consult your doctor to address the risks and benefits of continuing these medications in your case.
Next questionOsteoporosis and long-term prednisone use: Is there a connection?
- Kennel KA (expert opinion). Mayo Clinic, Rochester, Minn. April 4, 2008.
- Clinician's guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation. http://www.nof.org/professionals/NOF_Clinicians_Guide.pdf. Accessed Sept. 8, 2008.
- Black DM, et al. Effects of continuing or stopping alendronate after 5 years of treatment: The fracture intervention trial long-term extension (FLEX): A randomized trial. Journal of the American Medical Association. 2006;296(24):2927-2938.
- Osteonecrosis of the jaw. American Dental Association. http://www.ada.org/public/topics/osteonecrosis.asp. Accessed Sept. 8, 2008.
- Drake MT, et al. Bisphosphonates: Mechanism of action and role in clinical practice. Mayo Clinic Proceedings. 2008;83(9):1032-1045.
