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J Bone Metab. 2015 Nov;22(4):167-174. English. Clinical Trial. https://doi.org/10.11005/jbm.2015.22.4.167
Lee SH , Gong HS , Kim TH , Park SY , Shin JH , Cho SW , Byun DW .
Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea.
Department of Orthopedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea. byundw@schmc.ac.kr
Abstract

Bisphosphonates have been widely used in the treatment of osteoporosis with robust data from many placebo-controlled trials demonstrating its efficacy in fracture risk reduction over 3 to 5 years of treatment. Although bisphosphonates are generally safe and well tolerated, concerns have emerged about the adverse effects related to its long-term use, including osteonecrosis of the jaw and atypical femur fractures. Because bisphosphonates are incorporated into the skeleton and continue to exert an anti-resorptive effect for a period of time after the discontinuation of drugs, the concept of a "drug holiday" has emerged, whereby the risk of adverse effects might be decreased while the patient still benefits from anti-fracture efficacy. As randomized clinical trial evidence is not yet available on who may qualify for a drug holiday, there is considerable controversy regarding the selection of candidates for the drug holiday and monitoring during a drug holiday, both of which should be based on individual assessments of risk and benefit. This statement will provide suggestions for clinicians in South Korea on the identification of possible candidates and monitoring during a bisphosphonate drug holiday.

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