When to Stop the Bisphosphonate

Charles P. Vega, MD


May 31, 2019

Welcome to Cases in Deprescribing. In this series, I will present a common clinical scenario drawn from my own practice, and hopefully familiar to virtually all of our readers. I will tell you what I plan to do, but I am more interested in crowdsourcing a response from all of you to collectively determine best practice.

Please answer the polling question and contribute to the comments section with your own thoughts, particularly when you disagree with me.

Case Presentation

You are seeing a 70-year-old white woman for a routine follow-up visit. Her history is significant for type 2 diabetes, stage 3 chronic kidney disease (estimated glomerular filtration rate [eGFR], 47 mL/min/m2), hypertension, and osteoporosis. Her body mass index is 32 kg/m2.

She began treatment with alendronate weekly 5 years ago after dual-energy x-ray absorptiometry (DEXA) revealed a T score in the osteoporosis range (T = -2.60). However, she has never sustained a fracture, and her family history is negative for both osteoporosis and fracture. She is a nonsmoker. She recalls using prednisone for a week about 15 years ago when she had a bad rash.

Her current medication regimen includes:

  • Benazepril;

  • Amlodipine;

  • Metformin;

  • Pioglitazone;

  • Atorvastatin;

  • Calcium with vitamin D; and

  • Alendronate.


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