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

Ditte Beck Jepsen*, Emilie Sofie Bergen, Jeffrey Pan, Eveline van Poelgeest, Abdiaziz Osman, Alaa Burghle, Jesper Ryg, Wade Thompson, Carina Lundby

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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.

Original languageEnglish
JournalEuropean Geriatric Medicine
Volume14
Issue number4
Pages (from-to)747–760
ISSN1878-7649
DOIs
Publication statusPublished - Aug 2023

Bibliographical note

Publisher Copyright:
© 2023, The Author(s), under exclusive licence to European Geriatric Medicine Society.

Keywords

  • Bisphosphonates
  • Deprescribing
  • Guidelines
  • Old age
  • Osteoporosis
  • Systematic review

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