Why might a bisphosphonate treatment be paused after several years?

• A. To increase fracture risk
• B. Because bone density cannot be measured during therapy
• C. To minimize adverse events such as osteonecrosis of the jaw or atypical femoral fractures
• D. To cure osteoporosis

Answer: (C)

Long-term suppression of bone turnover by bisphosphonates reduces fracture risk but carries a small risk of rare but serious adverse events when therapy is continued for many years. These adverse events include osteonecrosis of the jaw and atypical femoral fractures. Pausing treatment after several years can lower the likelihood of these events while the drug’s effects in bone persist, since bisphosphonates bind to bone and remain active for an extended period before remodeling activity returns toward normal. This approach helps balance ongoing fracture protection with a reduced risk of harm, and decisions are tailored to the individual’s fracture risk, bone density, age, and overall health. Bone density testing can still be performed if needed, and osteoporosis is not considered cured by stopping therapy.