porozendoОстеопороз и остеопатииOsteoporosis and Bone Diseases2072-26802311-0716Endocrinology Research Centre10.14341/osteo13145porozendo-13145Research ArticleНАУЧНЫЕ ОБЗОРЫREVIEWSРезультаты отмены бисфосфонатов: продолжительность антирезорбтивной активности, переломы, изменения МПК и маркеров костного обменаResults of bisphosphonate withdrawal: duration of antiresorptive activity, fractures, changes in BMD and bone turnover markershttps://orcid.org/0000-0002-7856-1567БеловаК. Ю.BelovaK. Yu.

Белова Ксения Юрьевна - доктор медицинских наук, заведующая кафедрой общественного здоровья и здравоохранения.

150000, Ярославль, ул. Революционная, д. 5

Researcher ID: 272353; Scopus Author ID: 211009011586

Kseniya Yu. Belova - MD, PhD.

Yaroslavl

Researcher ID: 272353; Scopus Author ID: 211009011586

Ksbelova@mail.ruhttps://orcid.org/0000-0003-3175-2910ЕршоваО. Б.ErshovaO. B.

Ершова Ольга Борисовна - доктор медицинских наук, профессор кафедры терапии Института последипломного образования.

Ярославль

Researcher ID: I-9576-2017; Scopus Author ID: 16734008200; Author ID: 319822

Ol’ga B. Ershova - MD, PhD.

Yaroslavl

Researcher ID: I-9576-2017; Scopus Author ID: 16734008200; Author ID: 319822

yarosteoporosis@list.ruhttps://orcid.org/0000-0002-1763-0725СкрипниковаИ. А.SkripnikovaI. A.

Скрипникова Ирина Анатольевна - доктор медицинских наук, руководитель отдела профилактики остеопороза и коморбидных состояний.

Москва

Researcher ID: O-4772-2016; Scopus Author ID: 6602554529

Irina A. Skripnikova - MD, PhD.

Moscow

Researcher ID: O-4772-2016; Scopus Author ID: 6602554529

ISkripnikova@gnicpm.ruФГБОУ ВО «Ярославский государственный медицинский университет» МЗ РФРоссияYaroslavl State Medical UniversityRussian FederationФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» МЗ РФРоссияNational Medical Research Center for therapy and preventive medicineRussian Federation2023170320242631824Copyright © Белова К.Ю., Ершова О.Б., Скрипникова И.А., 20242024Белова К.Ю., Ершова О.Б., Скрипникова И.А.Belova K.Y., Ershova O.B., Skripnikova I.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.osteo-endojournals.ru/jour/article/view/13145

В обзоре обсуждается возможность отмены бисфосфонатов (БФ), основанная на механизме действия препаратов, продолжительности их антирезорбтивной активности, критерии отмены и возврата к терапии. БФ обладают уникальной особенностью — сохранением клинического эффекта на протяжении длительного времени после отмены. Поскольку терапия БФ проводится длительно, накопление их в костной ткани — с одной стороны, и риск развития тяжелых нежелательных явлений — с другой стороны, послужили поводом для обсуждения концепции временной отмены препаратов и организации «лекарственных каникул». Основными критериями, на которые опираются в вопросе об отмене БФ и повторном назначении в настоящее время, являются: 1) риск развития новых переломов; 2) изменение минеральной плотности костной ткани (МПК) и 3) динамика маркеров костного метаболизма. Проведенные исследования позволяют предполагать, что приостановка лечения после 3–5-летней непрерывной терапии БФ возможна у женщин, не имеющих низких показателей МПК по окончании курса терапии, в то время как при сохраняющихся низких уровнях МПК вероятна дополнительная польза от продолжения терапии. Потеря костной массы в проксимальном отделе бедра и сохранение ее в позвоночнике через 2 года после прекращения лечения БФ объясняется разной локализацией и более длительным воздействием их на костный обмен в губчатой кости, т.е. в позвоночнике. Доставка и поглощение БФ в позвоночнике могут быть более интенсивными, чем в других отделах скелета. Отслеживание уровня маркеров во время перерыва в лечении БФ может быть полезно для определения момента возобновления терапии: если их концентрация приближается к исходному (до начала лечения), следует переоценить состояние пациента и обсудить вопрос о возобновлении терапии. Стоит отметить, что оптимальная продолжительность «лекарственных каникул» не установлена и должна подбираться индивидуально в зависимости от клинических обстоятельств, учитывая наличие переломов, значительное снижение МПК или увеличение маркеров костного метаболизма, а также наличие и/или появление новых клинически значимых факторов риска.

The review discusses the possibility of discontinuation of bisphosphonates (BPs), based on the mechanism of action of the drugs, the duration of their antiresorptive activity, criteria for discontinuation and return to therapy. BPs have a unique feature – maintaining the clinical effect for a long time after their withdrawal. Since BPs therapy is carried out for a long time, their accumulation in bone tissue, on the one hand, and the risk of developing severe adverse events, on the other hand, gave rise to discussion on the concept of temporary withdrawal of drugs and the organization of «drug holidays». The main criteria that are relied upon in the question of discontinuation of BPs and re-prescription at present are: 1) the risk of developing new fractures, 2) changes in bone mineral density (BMD), 3) dynamics of markers of bone metabolism. The conducted studies suggest that the suspension of treatment after 3-5 years of continuous therapy with BPs is possible in women who do not have low BMD indicators at the end of the course of therapy, while with continuing low levels of BMD, additional benefits from continuing therapy are likely. The loss of bone mass in the proximal femur and its preservation in the spine 2 years after discontinuation of BPs treatment is explained by their different localization and longer-term effect on bone metabolism in the spongy bone, i.e. in the spine. Delivery and absorption of BPs in the spine may be more intense than in other parts of the skeleton. Tracking the level of markers during a break in the treatment of BPs can be useful to determine the time of resumption of therapy: if their concentration approaches the baseline (before treatment), the patient’s condition should be reassessed and the issue of resuming therapy should be discussed. It should be noted that the optimal duration of «drug holidays» has not been established and should be selected individually depending on clinical circumstances, taking into account the presence of fractures, a significant decrease in BMD or an increase in markers of bone metabolism, as well as the presence and/or appearance of new clinically significant risk factors.

бисфосфонатыбисфосфонаты для внутривенного введениялекарственные каникулыостеопорозные переломыминеральная плотность костимаркеры костного обменаbisphosphonatesbisphosphonates for intravenous administrationdrug holidaysosteoporotic fracturesbone mineral densitymarkers of bone metabolismReferencesDrake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc. 2008;83(9):1032-1045. doi: https://doi.org/10.4065/83.9.1032Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc. 2008;83(9):1032-1045. doi: https://doi.org/10.4065/83.9.1032Coxon FP, Thompson K, Roelofs AJ, et al. Visualizing mineral binding and uptake of bisphosphonate by osteoclasts and non-resorbing cells. Bone. 2008;42(5):848-860. doi: https://doi.org/10.1016/j.bone.2007.12.225Coxon FP, Thompson K, Roelofs AJ, et al. Visualizing mineral binding and uptake of bisphosphonate by osteoclasts and non-resorbing cells. Bone. 2008;42(5):848-860. doi: https://doi.org/10.1016/j.bone.2007.12.225Russell RG, Watts NB, Ebetino FH, Rogers MJ. Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int. 2008;19(6):733-759. doi: https://doi.org/10.1007/s00198-007-0540-8Russell RG, Watts NB, Ebetino FH, Rogers MJ. Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int. 2008;19(6):733-759. doi: https://doi.org/10.1007/s00198-007-0540-8Boskey AL, Spevak L, Ma Y, et al. Insights into the bisphosphonate holiday: a preliminary FTIRI study. Osteoporos Int. 2018;29(3):699-705. doi: https://doi.org/10.1007/s00198-017-4324-5Boskey AL, Spevak L, Ma Y, et al. Insights into the bisphosphonate holiday: a preliminary FTIRI study. Osteoporos Int. 2018;29(3):699-705. doi: https://doi.org/10.1007/s00198-017-4324-5Black DM, Schwartz AV, Ensrud KE, et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006;296(24):2927-2938. doi: https://doi.org/10.1001/jama.296.24.2927Black DM, Schwartz AV, Ensrud KE, et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006;296(24):2927-2938. doi: https://doi.org/10.1001/jama.296.24.2927Bone HG, Hosking D, Devogelaer JP, et al. Ten years' experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med. 2004;350(12):1189-1199. doi: https://doi.org/10.1056/NEJMoa030897Bone HG, Hosking D, Devogelaer JP, et al. Ten years' experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med. 2004;350(12):1189-1199. doi: https://doi.org/10.1056/NEJMoa030897Cosman F, Cauley JA, Eastell R, et al. Reassessment of fracture risk in women after 3 years of treatment with zoledronic acid: when is it reasonable to discontinue treatment? J Clin Endocrinol Metab. 2014; 99(12):4546-4554. doi: https://doi.org/10.1210/jc.2014-1971Cosman F, Cauley JA, Eastell R, et al. Reassessment of fracture risk in women after 3 years of treatment with zoledronic acid: when is it reasonable to discontinue treatment? J Clin Endocrinol Metab. 2014; 99(12):4546-4554. doi: https://doi.org/10.1210/jc.2014-1971Watts NB, Chines A, Olszynski WP, et al. Fracture risk remains reduced one year after discontinuation of risedronate. Osteoporos Int. 2008;19(3):365-372. doi: https://doi.org/10.1007/s00198-007-0460-7Watts NB, Chines A, Olszynski WP, et al. Fracture risk remains reduced one year after discontinuation of risedronate. Osteoporos Int. 2008;19(3):365-372. doi: https://doi.org/10.1007/s00198-007-0460-7Adams AL, Adams JL, Raebel MA, et al. Bisphosphonate drug holiday and fracture risk: a population-based cohort study. J Bone Miner Res. 2018;33(7):1252-1259. doi: https://doi.org/10.1002/jbmr.3420Adams AL, Adams JL, Raebel MA, et al. Bisphosphonate drug holiday and fracture risk: a population-based cohort study. J Bone Miner Res. 2018;33(7):1252-1259. doi: https://doi.org/10.1002/jbmr.3420S0lling AS, Christensen DH, Darvalics B, et al. Fracture rates in patients discontinuing alendronate treatment in real life: a populationbased cohort study. Osteoporos Int. 2021;32(6):1103-1115. doi: https://doi.org/10.1007/s00198-020-05745-xS0lling AS, Christensen DH, Darvalics B, et al. Fracture rates in patients discontinuing alendronate treatment in real life: a populationbased cohort study. Osteoporos Int. 2021;32(6):1103-1115. doi: https://doi.org/10.1007/s00198-020-05745-xPfeilschifter J, Steinebach I, Trampisch HJ, Rudolf H. Bisphosphonate drug holidays: risk of fractures and mortality in a prospective cohort study. Bone. 2020;138:115431. doi: https://doi.org/10.1016/j.bone.2020.115431Pfeilschifter J, Steinebach I, Trampisch HJ, Rudolf H. Bisphosphonate drug holidays: risk of fractures and mortality in a prospective cohort study. Bone. 2020;138:115431. doi: https://doi.org/10.1016/j.bone.2020.115431Mignot MA, Taisne N, Legroux I, et al. Bisphosphonate drug holidays in postmenopausal osteoporosis: effect on clinical fracture risk. Osteoporos Int. 2017;28(12):3431-3438. doi: https://doi.org/10.1007/s00198-017-4215-9Mignot MA, Taisne N, Legroux I, et al. Bisphosphonate drug holidays in postmenopausal osteoporosis: effect on clinical fracture risk. Osteoporos Int. 2017;28(12):3431-3438. doi: https://doi.org/10.1007/s00198-017-4215-9Curtis JR, Westfall AO, Cheng H, et al. Risk of hip fracture after bisphosphonate discontinuation: implications for a drug holiday. Osteoporos Int. 2008;19(11):1613-1620. doi: https://doi.org/10.1007/s00198-008-0604-4Curtis JR, Westfall AO, Cheng H, et al. Risk of hip fracture after bisphosphonate discontinuation: implications for a drug holiday. Osteoporos Int. 2008;19(11):1613-1620. doi: https://doi.org/10.1007/s00198-008-0604-4Chiha M, Myers LE, Ball CA, et al. Long-term follow-up of patients on drug holiday from bisphosphonates: realworld setting. Endocr Pract. 2013;19(6):989-994. doi: https://doi.org/10.4158/EP12425.ORChiha M, Myers LE, Ball CA, et al. Long-term follow-up of patients on drug holiday from bisphosphonates: realworld setting. Endocr Pract. 2013;19(6):989-994. doi: https://doi.org/10.4158/EP12425.ORBindon B, Adams W, Balasubramanian N, etal. Osteoporotic fractures during bisphosphonate drug holiday. Endocr Pract. 2018;24(2):163-169. doi: https://doi.org/10.4158/EP171975.ORBindon B, Adams W, Balasubramanian N, etal. Osteoporotic fractures during bisphosphonate drug holiday. Endocr Pract. 2018;24(2):163-169. doi: https://doi.org/10.4158/EP171975.ORCurtis JR, Saag KG, Arora T, et al. Duration of bisphosphonate drug holidays and associated fracture risk. Med Care. 2020;58(5):419-426. doi: https://doi.org/10.1097/MLR.0000000000001294Curtis JR, Saag KG, Arora T, et al. Duration of bisphosphonate drug holidays and associated fracture risk. Med Care. 2020;58(5):419-426. doi: https://doi.org/10.1097/MLR.0000000000001294Hayes KN, Brown KA, Cheung AM, et al. Comparative fracture risk during osteoporosis drug holidays after long-term Risedronate versus alendronate therapy: a propensity score-matched cohort study. Ann Intern Med. 2022;175(3):335-343. doi: https://doi.org/10.7326/M21-2512Hayes KN, Brown KA, Cheung AM, et al. Comparative fracture risk during osteoporosis drug holidays after long-term Risedronate versus alendronate therapy: a propensity score-matched cohort study. Ann Intern Med. 2022;175(3):335-343. doi: https://doi.org/10.7326/M21-2512Soiling AS, Christensen DH, Darvalics B, et al. Fracture rates in patients discontinuing alendronate treatment in real life: a populationbased cohort study. Osteoporos Int. 2021;32(6):1103-1115. doi: https://doi.org/10.1007/s00198-020-05745-xSoiling AS, Christensen DH, Darvalics B, et al. Fracture rates in patients discontinuing alendronate treatment in real life: a populationbased cohort study. Osteoporos Int. 2021;32(6):1103-1115. doi: https://doi.org/10.1007/s00198-020-05745-xCurtis JR, Chen R, Li Z, et al. The impact of the duration of bisphosphonate drug holidays on hip fracture rates [abstract]. 2017 ACR/ARHP Annual Meeting. San Diego, CA: Annals of the Rheumatic Diseases; 2017. Abstract number 828Curtis JR, Chen R, Li Z, et al. The impact of the duration of bisphosphonate drug holidays on hip fracture rates [abstract]. 2017 ACR/ARHP Annual Meeting. San Diego, CA: Annals of the Rheumatic Diseases; 2017. Abstract number 828Migliaccio S, Moretti A, Biffi A, et al. Medication holidays in osteoporosis: evidence-based recommendations from the Italian guidelines on ‘Diagnosis, risk stratification, and continuity of care of fragility fractures' based on a systematic literature review. Ther Adv Musculoskelet Dis. 2023;15:1759720X231177110. doi: https://doi.org/10.1177/1759720X231177110Migliaccio S, Moretti A, Biffi A, et al. Medication holidays in osteoporosis: evidence-based recommendations from the Italian guidelines on ‘Diagnosis, risk stratification, and continuity of care of fragility fractures' based on a systematic literature review. Ther Adv Musculoskelet Dis. 2023;15:1759720X231177110. doi: https://doi.org/10.1177/1759720X231177110Black DM, Schwartz AV, Ensrud KE, et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006;296(24):2927-2938. doi: https://doi.org/10.1001/jama.296.24.2927Black DM, Schwartz AV, Ensrud KE, et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006;296(24):2927-2938. doi: https://doi.org/10.1001/jama.296.24.2927Miller PD, Watts NB, Licata AA, et al. Cyclical etidronate in the treatment of postmenopausal osteoporosis: efficacy and safety after seven years of treatment. Am J Med. 1997;103:468-476. doi: https://doi.org/10.1016/s0002-9343(97)00278-7Miller PD, Watts NB, Licata AA, et al. Cyclical etidronate in the treatment of postmenopausal osteoporosis: efficacy and safety after seven years of treatment. Am J Med. 1997;103:468-476. doi: https://doi.org/10.1016/s0002-9343(97)00278-7Nayak S, Greenspan SL. A systematic review and meta-analysis of the effect of bisphosphonate drug holidays on bone mineral density and osteoporotic fracture risk. Osteoporos Int. 2019;30(4):705-720. doi: https://doi.org/10.1007/s00198-018-4791-3Nayak S, Greenspan SL. A systematic review and meta-analysis of the effect of bisphosphonate drug holidays on bone mineral density and osteoporotic fracture risk. Osteoporos Int. 2019;30(4):705-720. doi: https://doi.org/10.1007/s00198-018-4791-3Stock JL, Bell NH, Chesnut CH 3rd, et al. Increments in bone mineral density of the lumbar spine and hip and suppression of bone turnover are maintained after discontinuation of alendronate in postmenopausal women. Am J Med. 1997;103(4):291-297. doi: https://doi.org/10.1016/s0002-9343(97)00130-7Stock JL, Bell NH, Chesnut CH 3rd, et al. Increments in bone mineral density of the lumbar spine and hip and suppression of bone turnover are maintained after discontinuation of alendronate in postmenopausal women. Am J Med. 1997;103(4):291-297. doi: https://doi.org/10.1016/s0002-9343(97)00130-7Ensrud KE, Barrett-Connor EL, Schwartz A, et al. Randomized trial of effect of alendronate continuation versus discontinuation in women with low BMD: results from the fracture intervention trial long-term extension. J Bone Miner Res. 2004;19(8):1259-1269. doi: https://doi.org/10.1359/JBMR.040326Ensrud KE, Barrett-Connor EL, Schwartz A, et al. Randomized trial of effect of alendronate continuation versus discontinuation in women with low BMD: results from the fracture intervention trial long-term extension. J Bone Miner Res. 2004;19(8):1259-1269. doi: https://doi.org/10.1359/JBMR.040326McNabb BL, Vittinghoff E, Schwartz AV, et al. BMD changes and predictors of increased bone loss in postmenopausal women after a 5-year course of alendronate. J Bone Miner Res. 2013;28(6):1319-1327. doi: https://doi.org/10.1002/jbmr.1864McNabb BL, Vittinghoff E, Schwartz AV, et al. BMD changes and predictors of increased bone loss in postmenopausal women after a 5-year course of alendronate. J Bone Miner Res. 2013;28(6):1319-1327. doi: https://doi.org/10.1002/jbmr.1864Xu LH, Adams-Huet B, Poindexter JR, Maalouf NM. Determinants of change in bone mineral density and fracture risk during bisphosphonate holiday. Osteoporos Int. 2016;27(5):1701-1708. doi: https://doi.org/10.1007/s00198-015-3447-9Xu LH, Adams-Huet B, Poindexter JR, Maalouf NM. Determinants of change in bone mineral density and fracture risk during bisphosphonate holiday. Osteoporos Int. 2016;27(5):1701-1708. doi: https://doi.org/10.1007/s00198-015-3447-9Black DM, Reid IR, Boonen S, et al. The Effect of 3 Versus 6 Years of Zoledronic Acid Treatment of Osteoporosis: A Randomized Extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res. 2012;27(2):243-254. doi: https://doi.org/10.1002/jbmr.1494Black DM, Reid IR, Boonen S, et al. The Effect of 3 Versus 6 Years of Zoledronic Acid Treatment of Osteoporosis: A Randomized Extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res. 2012;27(2):243-254. doi: https://doi.org/10.1002/jbmr.1494Naylor KE, Bradburn M, Paggiosi MA, et al. Effects of Discontinuing Oral Bisphosphonate Treatments for Postmenopausal Osteoporosis on Bone Turnover Markers and Bone Density. Osteoporos Int. 2018;29(6):1407-1417. doi: https://doi.org/10.1007/s00198-018-4460-6Naylor KE, Bradburn M, Paggiosi MA, et al. Effects of Discontinuing Oral Bisphosphonate Treatments for Postmenopausal Osteoporosis on Bone Turnover Markers and Bone Density. Osteoporos Int. 2018;29(6):1407-1417. doi: https://doi.org/10.1007/s00198-018-4460-6Kim TY, Bauer DC, McNabb BL, et al. Comparison of BMD Changes and Bone Formation Marker Levels 3 Years After Bisphosphonate Discontinuation: FLEX and HORIZON-PFT Extension I Trials. J Bone Miner Res. 2019;34(5):810-816. doi: https://doi.org/10.1002/jbmr.3654Kim TY, Bauer DC, McNabb BL, et al. Comparison of BMD Changes and Bone Formation Marker Levels 3 Years After Bisphosphonate Discontinuation: FLEX and HORIZON-PFT Extension I Trials. J Bone Miner Res. 2019;34(5):810-816. doi: https://doi.org/10.1002/jbmr.3654Bauer DC, Schwartz A, Palermo L, et al. Fracture prediction after discontinuation of 4 to 5 years of alendronate therapy: the FLEX study. JAMA Intern Med. 2014;174(7):1126-1134. doi: https://doi.org/10.1001/jamainternmed.2014.1232Bauer DC, Schwartz A, Palermo L, et al. Fracture prediction after discontinuation of 4 to 5 years of alendronate therapy: the FLEX study. JAMA Intern Med. 2014;174(7):1126-1134. doi: https://doi.org/10.1001/jamainternmed.2014.1232Vasikaran S, Cooper C, Eastell R, et al. International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine position on bone marker standards in osteoporosis. Clin Chem Lab Med. 2011;49(8):1271-1274. doi: https://doi.org/10.1515/CCLM.2011.602Vasikaran S, Cooper C, Eastell R, et al. International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine position on bone marker standards in osteoporosis. Clin Chem Lab Med. 2011;49(8):1271-1274. doi: https://doi.org/10.1515/CCLM.2011.602Black DM, Reid IR, Cauley JA, et al. The effect of 6 versus 9 years of zoledronic acid treatment in osteoporosis: a randomized second extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res. 2015;30(5):934-944. doi: https://doi.org/10.1002/jbmr.2442Black DM, Reid IR, Cauley JA, et al. The effect of 6 versus 9 years of zoledronic acid treatment in osteoporosis: a randomized second extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res. 2015;30(5):934-944. doi: https://doi.org/10.1002/jbmr.2442Eastell R, Hannon RA, Wenderoth D, et al. Effect of stopping risedronate after long-term treatment on bone turnover. J Clin Endocrinol Metab. 2011;96(11):3367-3373. doi: https://doi.org/10.1210/jc.2011-0412Eastell R, Hannon RA, Wenderoth D, et al. Effect of stopping risedronate after long-term treatment on bone turnover. J Clin Endocrinol Metab. 2011;96(11):3367-3373. doi: https://doi.org/10.1210/jc.2011-0412Ashcherkin N, Patel AA, Algeciras-Schimnich A, Doshi KB. Bone turnover markers to monitor oral bisphosphonate therapy. Cleve Clin J Med. 2023;90(1):26-31. doi: https://doi.org/10.3949/ccjm.90a.22002Ashcherkin N, Patel AA, Algeciras-Schimnich A, Doshi KB. Bone turnover markers to monitor oral bisphosphonate therapy. Cleve Clin J Med. 2023;90(1):26-31. doi: https://doi.org/10.3949/ccjm.90a.22002Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis - 2020 update. EndocrPract. 2020;26(Suppl 1):1-46. doi: https://doi.org/10.4158/GL-2020-0524SUPPLCamacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis - 2020 update. EndocrPract. 2020;26(Suppl 1):1-46. doi: https://doi.org/10.4158/GL-2020-0524SUPPLEastell R, Rosen CJ, Black DM, et al. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2019;104(5):1595-1622. doi: https://doi.org/10.1210/jc.2019-00221Eastell R, Rosen CJ, Black DM, et al. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2019;104(5):1595-1622. doi: https://doi.org/10.1210/jc.2019-00221

The authors declare that there are no conflicts of interest present.