Drug Holiday

As our summer holidays come to an end, I would like to talk about the idea of going on a drug holiday. This could be interpreted in a variety of different ways but I what I am talking about is taking a break from our medications. This term was made popular with some of the medications for osteoporosis. 

When someone has been diagnosed with osteoporosis and starts to take a medication to stop the deterioration of the bone, is the big question is: " For how long will I need to take it?" Well, it will take at least a year to see some improvement in bone density and maybe even longer. We are often pleased when we stop seeing loss of bone in a year's time. Everyday our bones break down and rebuild to become stronger. As we get older, the breaking down process is happening faster than the rebuilding. The medications work by telling the bone to stop breaking down. We then need to help our bones rebuild by supplying them with the right building materials such as calcium and vitamin D. Exercise and muscular activity are like the foremen instructing the bones to grow.

There is a theory that if we tell the bones to stop breaking down for too long we may be building new bone on old weak bone which does not provide a good foundation. This may happen if we continue to take a medication for too long. And thus, the idea of a Drug Holiday is born.

A drug holiday only benefits certain people and certain medications. The bisphosphonates are a class of oral medications often taken once weekly or once a month. Examples are Alendronate and Risedronate. These drugs stay in our bone for a very long time. If someone has been on one of these bisphosphates for 5 years, has seen improvement  and now has a low risk of fracture, they may qualify for a "drug holiday" and may temporarily stop their medication. While on "holiday", the drug will still remain in the bone protecting it for some time. This decision to go on holiday would need to be assessed by their doctor and reassessed annually to determine if and when they need to restart. We don't usually get to go on vacation forever do we?

What is important to note is that there is another very common injectable drug for osteoporosis. It is called denosumab and it is given every 6 months at the doctor's office. Although the injection is given every 6 months, the medication does not stay in the bone much longer than this. When a patient misses their injection, we start to see deterioration quite quickly. This medication would not qualify for a drug holiday. 

Whether you get to go on a drug holiday or not, let's get out there and enjoy these last few days of summer holidays. We are bound to absorb a little more vitamin D and those muscles will tell out bones to start growing.