Bisphosphonate 'holidays' is a recent hot topic, addressed by recent evidence from the National Osteoporosis Guideline Group (NOGG) in January 2016.

After a five year period for oral bisphosphonates (three years for IV zoledronate), treatment should be re-assessed for ongoing treatment, with an updated FRAX score and DEXA scan.

This guidance separates patients into high and low risk groups. To fall into the high risk group, one of the following must be true:

• Age >75
• Glucocorticoid therapy
• Previous hip/vertebral fractures
• Further fractures on treatment
• High risk on FRAX scoring
• T score <-2.5 after treatment

If any of the high risk criteria apply, treatment should be continued indefinitely, or until the criteria no longer apply. If they are in the low risk group however, treatment may be discontinued and re-assessed after two years, or if a further fracture occurs.