By vgreene, 13 March, 2015 Individualize drug tx: no drug tx duration should be considered indefinite. Given absence of evidence-based guidance, no universal recommendations apply to all pts
By vgreene, 13 March, 2015 If considering “drug holiday”: re-√ vertebral imaging, as med d/c not recommended if recent vertebral fx. Biochemical markers<sup>63</sup> may help determine “drug-holiday” duration.
By vgreene, 13 March, 2015 If modest fx risk after initial tx: reasonable to d/c bisphosphonates<sup>64</sup> after 3-5 yrs. If d/c meds: monitor serially for fx/falls/new chronic diseases; consider serial BMD, biochemical markers, vertebral imaging
By vgreene, 13 March, 2015 If high fx risk: consider continued tx w/ bisphosphonate or alternative tx<sup>63,64</sup>
By vgreene, 13 March, 2015 After initial 3-5 yrs of tx, do comprehensive risk assessment (hx, incl. intercurrent fxs and new chronic conditions, med list, √ BMD, √ ht; if ht ↓, then √ vertebral imaging)<sup>63</sup>
By vgreene, 13 March, 2015 Monitor at least annually while on meds. After 1-2 yrs (or sooner) re-assess BMD + labs; individualize drug duration
By vgreene, 13 March, 2015 Consider √ biochemical markers<sup>62</sup> to assess tx effect after 3–6 mo
By vgreene, 13 March, 2015 If new documented ht ↓, new back pain/posture change or suspicious CXR finding: √ repeat vertebral imaging;<sup>61</sup> otherwise, repeat imaging not indicated
By vgreene, 13 March, 2015 √ central DXA<sup>59,60</sup> BMD 1-2 yrs after tx start, then q2 yrs (or more frequently). If no major risk factors w/ initial T-score NL/upper-low bone mass range: may extend interval b/t BMDs