Number needed to treat is 36 for continuing alendronate.-Although patients with lower BMD or previous fracture had a higher risk of fractures, there was no statistically significant benefit seen in these subgroups.Two smaller, flawed studies examining discontinuation of bisphosphonates (without randomization) also found those discontinuing therapy had lower BMD,Interpreting osteoporosis studies is challenging: there is considerable heterogeneity among populations studied, how BMD is reported, and fracture classifications; there is large variability in BMD scoresObservational studies demonstrate potential adverse events with bisphosphonates (gastrointestinal, bone).No consensus exists regarding optimal duration of bisphosphonate therapy. Bone mineral density (BMD) was the primary outcome measure with fractures assessed as exploratory endpoints or collected as adverse events. Words from the wise about Cymbalta: Ive been taking 90 mg of cymbalta for over 5 years for fibro and nerve pain. Consider sequential therapy with other nonbisphosphonate agents as well. Tapering a medication means working with your doctor to develop a plan to take progressively smaller doses of a drug over an extended period of time. Effect of stopping risedronate after long-term treatment on bone turnover. Cymbalta, also known as duloxetine, is a selective serotonin reuptake inhibitor (SSRI) used mainly to treat depression. The authors conclude, "the results show continued efficacy in both the groups and do not provide convincing evidence of a benefit from continuing annual zoledronic acid infusions for more than six years." During this time, you may experience a number of symptoms, including:
Among those experiencing withdrawal symptoms, about Cymbalta (duloxetine) is a prescription medication used to treat depression, anxiety, fibromyalgia, and diabetic neuropathy. Although quitting Cymbalta cold turkey is rarely dangerous, it is best to consult your doctor before attempting to do so. Typically, this means continuing with a therapeutic dose of antidepressants to reduce the risk of relapse. This study is consistent with an analysis of one dose of Reclast that showed fracture-reduction benefit for about three years. Recent concerns about potential long-term safety issues, such as atypical femoral fractures (AFFs), osteonecrosis of the jaw (ONJ), and esophageal cancer, along with the possibility that fracture risk reduction may persist for years after treatment is stopped, have resulted in interrupting or stopping bisphosphonate therapy.However, many questions surround optimal treatment duration, which patients may discontinue treatment, and what the retreatment criteria should be. Expert opinion is based on limited data. Other forms of maintenance therapy include psychotherapy. Ⓒ 2020 About, Inc. (Dotdash) — All rights reserved
In addition, the results suggest the residual effect of discontinuing zoledronic acid after six years compared with three years provides a larger effect, supporting continuing use up to six years. Although this article focuses on long-term treatment of osteoporosis, the fact is that many older people at high risk of fracture receive no treatment, and even when prescribed, patients' nonadherence with drug therapy is widespread. Experts continue to suggest STOPPING bisphosphonates (alendronate, etc) after 3 to 5 years in patients at low fracture risk.. Bisphosphonates persist in the bones for years, so 3 to 5 years of therapy is enough for many patients. 4. This article attempts to put into perspective the long-term use of bisphosphonate therapy for the management of postmenopausal osteoporosis. The majority of participants in the duloxetine (Cymbalta) studies categorized their symptoms as either mild or moderate. When you quit Cymbalta, it can take your brain some time to adjust to being without it. The results of this study mirrors the recommendations of the FDA that patients on bisphosphonate therapy should be reevaluated after 3-5 years of therapy. considered in low-risk patients and in select patients at moderate risk of fracture after 3 to 5 years of therapy. Work with your doctor to develop a tapering schedule that fits your needs. The mean serum levels of bone turnover markers measured remained within the premenopausal reference range in both groups. It is unclear whether or not a slow Cymbalta taper will always prevent withdrawal symptoms, but it is generally considered the safest way to stop an antidepressant. Follow-up measurements of dual-energy X-ray absorptiometry and bone turnover markers after discontinuation were not associated with fracture risk and were not recommended methods of assessment.Expert opinion provides some guidance based on studies covered in the earlier section, but it is important to note these recommendations have not been evaluated in prospective trials.The first step is to evaluate your patient's risk for fracture.
The effects of nine years of zoledronic acid showed small differences in total hip BMD mean change between groups from years six to nine.