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Oral Bisphosphonates: Clinical Flowchart for long term treatment and monitoring. (National Osteoporosis Guideline Group NOGG)

Introduction:

Plan to prescribe oral bisphosphonates (alendronate (alendronic acid), ibandronate and risedronate) for at least 5 years and then re-assess fracture risk. Longer durations of treatment, for at least 10 years, are recommended in the following men and women:

    • Age ≥70 years at the time that the bisphosphonate is started
    • Who have a previous history of a hip or vertebral fracture(s)
    • Treated with oral glucocorticoids ≥7.5 mg prednisolone/day or equivalent
    • Who experience one or more fragility fractures during the first 5 years of treatment (if treatment is not changed).

If a new fracture occurs after bisphosphonate treatment is discontinued, reassess using FRAX and restart treatment.

If bisphosphonate treatment is discontinued (treatment pause/break drug) and no new fracture occurs, reassess using FRAX after 18 months for risedronate/ibandronate and 2 years for alendronate to inform whether treatment should be restarted.

Resource:

Related Information:

Link:

https://www.nogg.org.uk/full-guideline/section-7-strategies-management-osteoporosis-and-fracture-risk (Figure 4)

 

Reference:

National Osteoporosis Guideline Group (NOGG) UK. Clinical Guideline for the Prevention and Treatment of Osteoporosis, https://www.nogg.org.uk/full-guideline (2021, accessed 28 March 2024).