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Title: To stop or not to stop, that is the question.
Austin Authors: Seeman, Ego 
Affiliation: Department of Endocrinology, Austin Health, University of Melbourne, Australia
Issue Date: 1-Feb-2009
Publication information: Osteoporosis International : A Journal Established As Result of Cooperation Between the European Foundation For Osteoporosis and the National Osteoporosis Foundation of The Usa; 20(2): 187-95
Abstract: Treatment aimed at preventing fractures should be stopped if evidence of continued antifracture efficacy is lacking, if continued treatment increases bone fragility by adversely affecting matrix properties, and if stopping does not increased bone fragility. Credible evidence of antifracture efficacy beyond 5 years is lacking because of attrition of the cohort originally allocated to treatment or placebo and lack of controls. Prolonged suppression of remodeling is associated with accumulation of microdamage, advanced glycation products and increased tissue mineral density in animal studies but the structural benefits appear to out weight these adverse effects. Atypical minimal trauma subtrochanteric fractures are associated with prolonged treatment in human subjects but these are exceedingly rare. Stopping treatment does result in the reemergence of remodeling, rapidly with some drugs, more slowly with others while fracture rates are increased in poor compliers to treatment. Thus, within the constraints of limited evidence, I infer that stopping therapy is more likely to do net harm than continuing therapy - treatment should be continued in the majority of individuals.
Gov't Doc #: 19096746
DOI: 10.1007/s00198-008-0813-x
Type: Journal Article
Subjects: Aged
Bone Density.drug effects
Bone Density Conservation Agents.therapeutic use
Bone Remodeling.drug effects
Diphosphonates.therapeutic use
Fractures, Bone.prevention & control
Middle Aged
Osteoporosis, Postmenopausal.drug therapy
Refusal to Treat
Time Factors
Treatment Outcome
Appears in Collections:Journal articles

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