Little gain, high risk from long-term bisphosphonates

Given the rare but serious side-effects linked to prolonged use of the therapy, including atypical subtrochanteric fracture and osteonecrosis of the jaw, commentary published online in the New England Journal of Medicine called for reconsideration of which patients are given the drugs and for how long.

Patients with low bone mineral density at the neck after three to five years of treatment were at highest risk for vertebral fractures and are therefore the most likely to benefit from continued treatment, the authors suggest. Those with existing vertebral fractures who