Taking time off from osteoporosis medications is recommended after three to five years, but in the case of the drug risedronate, this hiatus also is tied to an increased risk of fracture among older adults, a new study finds.

Participants included 25,000 matched pairs of adults aged 66 years or older who had taken either the bisphosphonate drugs risedronate or alendronate for three or more years. Investigators compared rates of hip fracture between the pairs within three years after a 120-day ascertainment period.

Risedronate holidays were linked to an 18% higher rate of subsequent hip fracture, although the absolute risk was very small, reported Kaleen N. Hayes, PharmD, Ph.D., of the Brown University School of Public Health, and colleagues. The association was not as strong when any fracture was taken into account or with shorter drug holidays, they noted.

Risedronate leaves the body more quickly than alendronate, so the remaining length of fracture protection when patients are on a drug holiday may be shorter, Hayes and colleagues theorized. 

“Future research should examine how best to mitigate this risk,” the authors concluded.

Bisphosphonates are known to prevent life-changing fractures in older adults with osteoporosis, but long-term use of the drugs can have troubling side effects, including bone breakdown in certain areas of the body,therefore the drug holiday recommendations.

Full findings were published in the Annals of Internal Medicine.