Polypharmacy Guidance: appropriate prescribing, making medicines safe, effective and sustainable 2025 - 2028

This hot topic considers the appropriateness of antiresorptive therapy (e.g. bisphosphonates, denosumab) including duration of treatment  to reduce fracture risk in the management of osteoporosis.

• Consider likely life expectancy/prognosis when deciding whether to prescribe bisphosphonates for postmenopausal women with osteoporosis, therapy is most likely to benefit those who have a life expectancy greater than 12.4 months.
• Low-to-moderate risk patients who are stable after five years of taking oral bisphosphonates or, after three years with intravenous zoledronic acid, may be considered for a ‘drug holiday’
• Individuals taking prednisolone 7.5mg daily for three months or more should be offered antiresorptive treatment. This includes those taking repeated short courses of prednisolone (three or more in 12 months)