Role of the Pharmacist in Medication Therapy Management Services in Patients With Osteoporosis.

PURPOSE: This study aimed to review and summarize clinical trial data, updated guidelines, and expert opinions on the recommendations for drug holidays in patients being treated for osteoporosis.
METHODS: Three unique PubMed searches using the terms osteoporosis drug holiday, osteoporosis discontinuation, and osteoporosis extension produced 149 articles, of which 16 with relevance to postmenopausal osteoporosis and treatment discontinuation were selected. A separate search of 6 national societies with interest in the treatment of osteoporosis produced 2 guideline statements with specific mention of therapy duration.
FINDINGS: No pharmacologic therapy for osteoporosis should be considered indefinite. After 3 to 5 years of therapy, a comprehensive patient assessment of individualized risk for fracture should occur. In patients who are at mild to moderate risk for fracture after initial treatment, therapy with a bisphosphonate may be discontinued, whereas patients who remain at high risk for fracture should continue therapy. Although discontinuation with bisphosphonate agents may be appropriate due to mechanism of action and expected residual effects, which may last several years after discontinuation, discontinuation of shorter-acting agents (nonbisphosphonate agents) will result in a rapid reversal of therapeutic benefits and may not be appropriate. Patients who undergo a drug holiday should be monitored and reassessed for re-initiation of therapy. Caution should be employed by readers generalizing results to male patients with osteoporosis as pivotal trial data are limited to postmenopausal women with osteoporosis. IMPLICATIONS: Pharmacists play a crucial role in ensuring that patients achieve optimal therapeutic outcomes. This achievement is partly accomplished through medication-adherence monitoring and education. Most chronic disease states require that patients remain on therapy, even when asymptomatic, for an indefinite period to meet and maintain therapeutic goals. To improve health-related outcomes, some pharmacist-managed medication therapy management programs are devoted entirely to treatment adherence. However, osteoporosis is a chronic disease state for which indefinite therapy may no longer be recommended due to potential long-term tolerability issues. It is crucial that the pharmacist understand the data and new guidelines addressing the optimal duration of therapy in osteoporotic patients so that they recognize which patients qualify for a drug holiday, do not mistakenly categorize a patient as nonadherent when therapy is stopped, and recommend when therapy should be restarted. This understanding will result in better patient management and health system cost-savings.