After how many years of treatment should a patient typically consider a "drug holiday" from oral bisphosphonates?

A drug holiday from oral bisphosphonates is typically considered after approximately 5 years of treatment. This recommendation is based on evidence suggesting that long-term use of bisphosphonates can lead to diminishing returns in efficacy, and that the potential risks associated with prolonged therapy, such as atypical femur fractures and osteonecrosis of the jaw, may increase over time.

The 5-year mark is seen as a balance between maintaining the therapeutic benefits of the medication—primarily in preventing fractures in individuals with osteoporosis—and minimizing the risks associated with long-term use. After this period, patients can be reassessed for their fracture risk, and a decision about whether to continue treatment or take a break can be made based on their current condition and risk factors.

Continuing the treatment beyond this period may still be appropriate for some patients, particularly those at higher risk of fractures or those who have not achieved optimal bone density improvements. However, the concept of a drug holiday provides an opportunity to evaluate the necessity of ongoing treatment while closely monitoring the patient’s bone health during that absence.