How long to treat and how long to rest — by fracture risk level
If you were started on a bisphosphonate for temporary reasons (e.g., short-term steroid use), treatment can be stopped. Reassess only if you have a new fracture or your risk factors change.
Oral bisphosphonates for 5 years or IV zoledronic acid for 3 years, then reassess. If T-score is above −2.5 and you're fracture-free, a 2–4 year holiday is reasonable. Reassess every 2–4 years during the break.
T-score ≤ −2.5 at femoral neck after treatment, history of vertebral or hip fracture, or multiple fragility fractures. Continue oral bisphosphonates up to 10 years (IV up to 6 years) before a 1–2 year holiday. Restart promptly if BMD declines.
Your physician may recommend continuous bisphosphonate treatment without a holiday, or a very short break with close monitoring. Consider anabolic-first approach (EVENITY or Forteo) followed by long-term bisphosphonate or Prolia.
Based on ACP 2023, AACE 2020, ASBMR Task Force 2016 • MelioGuide.com