Table 10.

Recommendations for bisphosphonate therapy.

Recommendations	Grading of recommendations	Quality of evidence
Initial treatment for patients at high fracture risk	I	A
Alternative treatment for patients at very high fracture risk who are unable to use osteoanabolic agents	IIa	A
Reassess fracture risk after 3–5 years of therapy	I	A
Consider a drug holiday if patients are no longer at high fracture risk (no history of fragility fracture and T-score > −2.5)	IIa	B
Consider reinitiating osteoporosis medications if declining in BMD or becoming a high fracture risk	IIa	B
Consider continuing treatment for up to 10 years (oral form) or 6 years (intravenous form) or switching to another therapy if remaining at high fracture risk or very high fracture risk before treatment	IIa	B

BMD: bone mineral density.