| Objective Through summarizing the key points of the EMAS position statement on “drug holiday”, providing reference to clinicians for the understanding of bisphosphonate or denosumab “drug holiday”, in order to enhance the treatment standard of osteoporosis. Methods EMAS performed systematic review on the effect of bisphosphonate and denosumab discontinuation on fracture risk, as well as its possible benefits in reducing the risk of adverse effects, and published the position statement. Results ① Considering the long-term efficacy and safety of bisphosphonates and fracture risk, individual treatment plan should be applied. ② Timing for drug holiday: discontinuation of bisphosphonates should be considered in all patients who have been treated for more than five years with alendronate, and more than three years with risedronate or zoledronic acid. ③ In view of the limited evidence for ibandronate, and the possibility of rebound fractures after denosumab discontinuation, drug holiday for ibandronate and denosumab is not recommended. ④ Length of drug holiday, in general 1-3 years for bisphosphonates is suggested. After this time, the patient should be reassessed. ⑤ Evaluation for treatment re-initiation: during bisphosphonates drug holiday, patients’ characteristics including age, history of falls, presence of new fracture, possible risk factors, bone mineral density and bio-markers of bone turnover should be considered. ⑥ Drugs for treatment re-initiation: bisphosphonates, denosumab, teriparatide, SERMs, MHT and strontium ranelate could be considered after a “drug holiday”. Conclusions The bisphosphonate drug holidays follow the principle of individuation and do not recommend the denosumab medicine holiday. |