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Recommendations on deprescribing of bisphosphonates in osteoporosis guidelines: a systematic review

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Key summary points

AbstractSection Aim

To examine whether and how osteoporosis guidelines include recommendations on deprescribing of bisphosphonates.

AbstractSection Findings

Osteoporosis guidelines include limited guidance on how to make individualized deprescribing decisions based on individual health context.

AbstractSection Message

More detailed deprescribing guidance may be warranted in osteoporosis guidelines to help prescribers and patients/caregivers make individualized decisions about bisphosphonate therapy for older persons. This should include considerations of treatment goals/preferences, assessment of life expectancy, and weighing benefits/risks of continuation versus deprescribing.

Abstract

Purpose

Advancing age, declining health status, and a shift in benefit/risk balance warrant judicious use of preventive medications in older persons, including consideration of deprescribing. Lack of guidance on deprescribing is a major barrier for prescribers to consider deprescribing in daily practice. The aim of this review was to evaluate to what extent osteoporosis guidelines include bisphosphonate deprescribing recommendations.

Methodology

We conducted a systematic review, searching PubMed, Embase, and grey literature. We included guidelines on treatment of osteoporosis with bisphosphonates. Two independent reviewers screened titles, abstracts, and full texts. Recommendations for deprescribing were extracted, and quality of guidelines were assessed.

Results

Among 9345 references, 42 guidelines were included. A total of 32 (76%) guidelines included deprescribing recommendations: 29 (69%) guidelines included non-specific deprescribing recommendations framed as a drug holiday, of which 2 (5%) also included specific deprescribing recommendations based on individual health context (e.g. life expectancy, frailty, function, preferences/goals). Twenty-four (57%) guidelines included practical deprescribing recommendations, and 27 (64%) guidelines included recommendations for when deprescribing should not be considered.

Conclusion

Bisphosphonate deprescribing recommendations in osteoporosis guidelines were primarily framed as drug holidays, with limited guidance on how to make individualized deprescribing decisions based on individual health context. This suggests a need for additional focus on deprescribing in osteoporosis guidelines.

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Authors and Affiliations

  1. Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark

    Ditte Beck Jepsen & Jesper Ryg

  2. Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark

    Emilie Sofie Bergen, Alaa Burghle & Carina Lundby

  3. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada

    Jeffrey Pan

  4. Department of Internal Medicine, Section of Geriatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

    Eveline van Poelgeest

  5. Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands

    Eveline van Poelgeest

  6. Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark

    Abdiaziz Osman, Alaa Burghle & Carina Lundby

  7. Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Jesper Ryg

  8. Department of Anesthesiology, Pharmacology and Therapeutics, Therapeutics Initiative, Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Wade Thompson

  9. Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark

    Wade Thompson & Carina Lundby

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Jepsen, D.B., Bergen, E.S., Pan, J. et al. Recommendations on deprescribing of bisphosphonates in osteoporosis guidelines: a systematic review. Eur Geriatr Med 14, 747–760 (2023). https://doi.org/10.1007/s41999-023-00820-y

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  • DOI: https://doi.org/10.1007/s41999-023-00820-y

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