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American Journal of  Medical Science 
and Innovation (AJMSI)

Atypical Femur Fractures in Post-Menopausal Patients Taking Bisphosphonates and 
Their Indication When to Start after Holiday Period of  5 Years and Its Effects   

Imran Azeem1*, Susan Gilchrist2, Kiran Dosani3, James Broderick1, Conor Hurson1

Volume 4 Issue 1, Year 2025
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v4i1.4156
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: December 01, 2024

Accepted: January 04, 2025

Published: March 19, 2025

Postmenopausal women are at risk of  fractures owing to osteoporosis, which is worsened 
by low oestrogen. Bisphosphonates like ibandronate, zoledronic acid, alendronate, and 
risedronate limit bone resorption and increase bone density, reducing fracture risk. Although 
atypical femur fractures (AFFs) are uncommon, they are associated with dangerous 
complications of  long-term bisphosphonate therapy. Early fracture identification before 
they occur is crucial to minimizing complications. The review examines bisphosphonate-
related medical issues in postmenopausal women with atypical femur fractures. The study 
also addressed whether to resume bisphosphonate medication following a pharmacological 
holiday, which reduces fracture risk. A thorough literature search was undertaken using 
PubMed, Embase, and the Cochrane Library. The search criteria included atypical femur 
fractures, bisphosphonates, osteoporosis, and therapy duration. Following screening, 
studies fulfilling inclusion criteria were assessed utilizing the Cochrane Risk of  Bias Tool 
and Newcastle-Ottawa Scale. Several studies examined the association between long-term 
bisphosphonate usage and atypical femur fractures. Bisphosphonates reduce osteoporotic 
fractures but may raise AFF risk over time. The studies also emphasize the significance 
of  individualized bisphosphonate treatment programs and thorough monitoring, especially 
after a medication holiday. Bisphosphonates reduce fracture risk, although atypical femur 
fractures require cautious treatment duration and timing, especially following a medication 
holiday. Selection bias and confounding variables may have limited the evidence of  this 
research. The research design and use of  real-world data may also affect its validity and 
reliability. To enhance treatment recommendations and patient outcomes, longitudinal 
research on bisphosphonates’ long-term impact on bone health and fracture risk is needed.

Keywords
Atypical Femur Fractures, 
Bisphosphonates, Effects of  
Bisphosphonate Resumption, Post-
Menopausal Patients

1 Orthopedic and Trauma Department, St. Vincent’s University Hospital, Dublin, Ireland
2 Orthopedic Department, Letterkenny University Hospital, County Donegal, Ireland
3  Internal Medicine, South City Hospital, Karachi, Pakistan
* Corresponding author’s e-mail: drimranazeem88@gmail.com

INTRODUCTION
Background
Postmenopausal women are particularly at risk of  
fractures from osteoporosis, a systemic skeletal condition 
that causes bone fragility (Ji & Yu, 2015). This group has 
increased osteoporotic fractures because of  hormonal 
variations, specifically a drop in oestrogen levels after 
menopause, which demineralizes bone (Walker & Shane, 
2023). It usually affects the wrist, pelvis, and vertebrae. 
Menopausal women often take bisphosphonates for 
osteoporosis. Bisphosphonates prevent fractures and 
increase bone density by inhibiting bone resorption 
(Khan et al., 2022). Bisphosphonates like ibandronate, 
zoledronic acid, alendronate, and risedronate enable 
customized treatment due to their dosage and formulation 
possibilities. Long-term bisphosphonate medication is 
linked to atypical femur fractures (AFFs). Adverse effects 
associated with fractures may be diminished as a result 
of  early detection and diagnosis of  AFFs before their 
complete formation. Single energy X-ray absorptiometry, 
a recently developed imaging technique, has been shown 
to detect incomplete atypical femoral fractures (iAFF) 
before their complete occurrence (McKenna et al., 2017).
Although bisphosphonates decrease the risk of  fractures, 
they can cause rare and adverse atypical femur fractures 
(Silverman et al., 2018). These radiographic pattern 

femur fractures can develop in the diaphyseal or the sub-
trochanteric region without trauma (Grygorieva et al., 
2023). Several research has associated bisphosphonates 
with atypical femur fractures while raising safety 
concerns specifically with its long-term intake (Black et 
al., 2019; Donnelly et al., 2012; Tile & Cheung, 2020). A 
comprehensive understanding is essential for the etiology, 
epidemiology, and risk factors of  atypical femur fractures 
to reduce the hazards of  bisphosphonates and enhance 
osteoporosis therapy (Hart, 2023). The British National 
Formulary recommends investigating each patient’s 
treatment responsiveness, fracture risk, and tolerance 
of  bisphosphonate therapy for osteoporosis before the 
initiation or discontinuation of  the treatment (Crawley, 
2019).
Examining the patient’s history of  treatment and bone 
condition is essential while considering bisphosphonate 
medication intake after the holiday. The risk of  adverse 
effects may increase as a consequence of  returning to 
therapy soon after a break due to the instability of  bone 
turnover. Long-term studies are required to assess the 
safety and efficacy of  bisphosphonate medication for 
atypical fractures. To address concerns about starting or 
discontinuing bisphosphonates after the holidays, even if  
they’re still needed to treat osteoporosis, understand each 
patient’s factors and treatment goals. 



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Rationale
A complete investigation is needed owing to the medical 
difficulties associated with atypical femoral fractures in 
postmenopausal women who take bisphosphonates and 
the absence of  a clear response about whether to resume 
treatment after a 5-year hiatus Bisphosphonates, which 
increase bone mineral density and prevent fractures, have 
raised concerns about atypical femur fractures, especially 
in postmenopausal women (Hart, 2024). Previous 
research reports that these fractures impede healing and 
therapy. After a 5-year gap, assess therapy resumption 
risk. Bisphosphonate users’ atypical femur fractures and 
their causes must be understood by doctors to make 
informed decisions and manage their patients. Some 
physicians prescribe a “drug holiday” for a few years to 
lessen the risk, whereas others emphasize treatment to 
prevent fractures.
Due to long-term risks such as atypical femur fractures, 
bisphosphonate medication duration, and resume 
timing are contested. These concerns have caused 
disagreements over treatment time despite its short- to 
medium-term fracture risk reduction. Understanding 
how bisphosphonate medicine decreases fractures and 
identifying biomarkers might help determine its impact 
on bone quality and microarchitecture post-holiday. 
Long-term effects of  bisphosphonate on bone quality, 
microarchitecture, and fracture reduction must be 
investigated to enhance clinical practice. Postmenopausal 
women at risk of  bisphosphonate-induced atypical femur 
fractures are the focus of  this meta-analysis.

Objectives
• To systematically examine the literature on atypical 

femur fracture risk in postmenopausal individuals using 
bisphosphonates for 5 years on holiday.

• To determine the best time to start bisphosphonate 
medication after the holidays to reduce the risk of  atypical 
fractures.

• To evaluate bisphosphonate discontinuation length 
post-holidays to preserve bone health and reduce fracture 
risk.

Questions
• What is the risk for atypical fracture once we start 

after the holiday?
• When shall we start bisphosphonate after the holiday 

period? 
• How long can we stop the intake of  bisphosphonate 

after the holiday period?

MATERIALS AND METHODS
This systematic review is executed based on the 
methodology permitting the Preferred Reporting Items 
for Systematic Reviews and Meta-Analysis (PRISMA) 
statements (Moher et al., 2009).

Search Strategy
A comprehensive search strategy is used to find relevant 

studies for this systematic review. The databases Embase, 
the Cochrane Library, and PubMed will be examined. 
The search strategy will include atypical femur fractures, 
bisphosphonates, osteoporosis, treatment duration, and 
fracture risk. The search strategy initially yielded 1,200 
articles from the selected databases. Titles and abstracts 
were used to evaluate these articles for future investigation. 
Duplicate articles were removed, leaving 800 entries for 
inquiry. All 800 articles were then evaluated for inclusion 
and exclusion criteria.
A total of  50 articles passed full-text screening for 
the systematic review, these articles were assessed for 
methodological rigor utilizing the Cochrane Risk of  Bias 
Tool and the Newcastle-Ottawa Scale for observational 
studies (Higgins et al., 2011; Wells et al., 2000). Changes 
in bone health throughout the holiday, atypical femur 
fractures, risk variables, and bisphosphonate treatment 
duration’s influence on fracture risk reduction are 
important results. This thorough analysis synthesizes 
data on atypical femur fractures in postmenopausal 
bisphosphonate-treated individuals. 9 articles met 
inclusion requirements. Table 1 below shows the 
keywords and MeSH terms utilized in the review. 

Table 1: Summary of  the searched keywords and MeSH 
terms
Category Keywords and MeSH Terms
Atypical Femur 
Fractures

Atypical femur fractures

Sub-trochanteric fractures
Diaphyseal fractures
Femoral shaft fractures

Bisphosphonates Bisphosphonates
Alendronate
Risedronate
Ibandronate
Zoledronic acid

Osteoporosis Osteoporosis
Postmenopausal osteoporosis
Bone density

Treatment Duration Treatment duration
Long-term treatment
Drug holiday

Study Selection Criteria
Data Extraction
The data extraction approach for this systematic review 
entails assessing and documenting important study 
features and outcome measures with care. These factors 
greatly impact the findings’ robustness and applicability. 
Cohort studies have long-term impacts, whereas 
randomized controlled trials provide high-quality data. 
The period of  follow-up also reveals the treatment effects’ 
temporal aspects (Yong & Logan, 2021). The review 



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Table 2: Inclusion and Exclusion Criteria of  the included studies
Criteria Inclusion Exclusion
Study Design Randomized controlled trials, case-control 

studies, cohort studies, and systematic reviews
Studies not meeting the specified study 
designs (e.g., case reports, letters, editorials)

Participants Postmenopausal patients Studies conducted in populations other 
than postmenopausal patients (e.g., men, 
premenopausal women)

Intervention Studies examining bisphosphonate treatment 
duration and timing of  initiation after a 
holiday period

Studies focusing solely on other 
osteoporosis treatments or interventions

Outcome Measures Studies reporting on atypical femur fractures Studies without relevant outcome 
measures (e.g., studies focusing solely on 
bone mineral density changes)

Reporting Quality - Studies with inadequate methodology or 
reporting, as assessed during the quality 
assessment process

Table 3: Quality Assessment
Study Selection Bias Performance 

Bias
Detection
Bias

Attrition
Bias

Reporting
Bias

Overall Risk 
of  Bias

(Bauer et al., 2024) Low High Low Low Low Uncertain
(Brown, 2021) Low Low Low High Low Low
(Fuggle et al., 2021) Low Low Low Low High Low
(Khan et al., 2022) Low Uncertain Low Low Low Low
(Morkos et al., 2022) Low High Low Low Low High
(Ogundipe, 2020) Low Low High Low Low Low
(Rudran et al., 2021) High Low Low Low Low Low
(Saag et al., 2021) Low Low Low High Low Low
(Toro et al., 2023) Low Low Uncertain Low Low High

rigorously evaluates these qualities to place the results 
in the context of  osteoporosis management. Detailed 
outcome metrics for atypical femoral fractures and 
bisphosphonate treatment are documented. A range of  
outcome indicators are used to assess the pros and cons of  
bisphosphonate treatment in postmenopausal individuals. 
During data extraction, bias, and methodological issues 
are carefully evaluated. Larger sample volumes and 
longer follow-ups may improve analytical significance. 
The review thoroughly evaluates the facts to satisfy the 
highest evidence synthesis standards and ensure the 
outcomes’ validity and reliability. This method collects and 
summarises data from several research, analyses patterns 

and similarities, and investigates variance explanations. 

Quality Assessment
Table 3 presented below highlights the quality of  the 
selected articles for the review. This table categorizes the 
possible bias of  each study utilizing the Cochrane Risk 
of  Bias Tool (Higgins et al., 2011). Each domain has a 
“Low,” “High,” or “Uncertain” bias risk. The analysis 
uses methodologically rigorous research, indicating little 
bias. Reviewers resolved quality evaluation discrepancies 
and disagreements via discourse. If  a consensus was 
not achieved, a third reviewer was hired to provide an 
objective assessment and help resolve the conflict. 

Data Synthesis and Analysis 
The selected studies included atypical femur fractures in 
postmenopausal bisphosphonate patients in a narrative 
format. Reference 1, studied Danish bisphosphonate use 
with uncommon femoral fractures in a case-cohort study. 
The research employed blinded radiography. Atypical 
femur fractures were infrequent in postmenopausal 
patients using bisphosphonates, supporting safety. The 
study emphasizes the need for thorough monitoring 

and adverse effect awareness, especially in long-term 
bisphosphonate users. The study discovered that extended 
postmenopausal osteoporosis treatments must be tailored 
to each patient’s needs (Brown, 2021). It also underlines 
the significance of  frequently monitoring the medicine 
and contemplating cessation after a break to reduce the 
risk of  adverse effects such as atypical femur fractures.
Researchers observed a gap in osteoporosis care, 
suggesting at-risk individuals were not addressed for 



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appropriate medications (Fuggle et al., 2021). Many eligible 
patients receive insufficient bisphosphonates or no 
treatment, increasing their risk of  osteoporotic fractures. 
Public awareness, educational accessibility, and evidence-
based therapy utilization are needed to reduce treatment 
disparities. After stopping chronic oral bisphosphonate 
therapy, the Study investigated mineral density and bone 
turnover post hoc (Saag et al., 2021). These findings 
suggest that bisphosphonate discontinuation needs 

switching medicines or monitoring for side effects. 

RESULTS AND DISCUSSIONS
Study Selection Process
Figure 1 shows the identified databases and screened 
studies involved in this systematic review while meeting 
the inclusion and exclusion criteria. The PRISMA flow 
diagram was created using PRISMA2020 (Haddaway et 
al., 2022).

Figure 1: PRISMA Chart demonstrating the study selection process

Table 2: Inclusion and Exclusion Criteria of  the included studies
Study Study Design Population Intervention Methodology
Bauer et al., 
2024)

Case-cohort 
study

Postmenopausal women 
receiving bisphosphonates

Bisphosphonate therapy Blinded radiog 
-raphic review

(Brown, 
2021)

Review article Postmenopausal women with 
osteoporosis

Long-term 
bisphosphonate treatment

Literature review

(Fuggle et 
al., 2021)

Review article Population at risk of  
osteoporosis and fractures

Osteoporosis therapy Literature review

(Khan et al., 
2022)

Guideline Postmenopausal women at 
risk of  osteoporosis

Management guidelines Guideline 
development

(Morkos et 
al., 2022)

Observational 
study

Patients with osteoporosis on 
a drug holiday

Osteoporosis medication 
selection

Real-world data 
analysis

(Ogundipe, 
2020)

Case report Postmenopausal woman with 
atypical femoral fractures

Long-term alendronate 
therapy

Case report

(Rudran et 
al., 2021)

Review article Patients with bisphosphonate-
associated fractures

Management strategies Literature review

Characteristics of  Included Studies



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(Saag et al., 
2021)

Post hoc analysis Postmenopausal women 
discontinuing oral 
bisphosphonates

Bisphosphonate 
discontinuation

Post hoc analysis 
of  clinical trial data

(Toro et al., 
2023)

Review article Patients at risk of  atypical 
femoral fractures

Fracture liaison service Literature review

Findings Related to Atypical Femur Fractures
Several studies which are presented above in Table 4 have 
shown the complicated link between bisphosphonate 
treatment and fracture risk. These studies found variable 
rates of  atypical femur fractures amongst postmenopausal 
bisphosphonate users. Atypical femur fractures may be 
prevented by bisphosphonates, according to blinded 
radiographic evaluation. However, it is reported that 
non-traumatic bilateral atypical femoral fractures in 
postmenopausal women use long-term alendronate 
(Ogundipe, 2020). 
Researchers advised diagnosing and treating 
bisphosphonate-induced atypical femoral fractures 
immediately to minimize complications (Rudran et 
al., 2021). Atypical femur fractures may be affected 
by patient characteristics, bisphosphonate duration, 
and risk variables, confounding fracture susceptibility 
assessment. When restarting bisphosphonate medication, 
our findings emphasize the necessity to adapt it to each 
patient’s requirements and goals. The BNF chapter on 
bisphosphonate medication duration in osteoporosis 
highlights fracture risk, response, and drug tolerance in 
tailored treatment programs. 
The condition of  patients during exceptionally long 
therapy periods (e.g., over ten years) is less certain. Whilst 
it would be more acceptable to adopt a more precise 
definition of  “high risk” in light of  these considerations, 
it remains feasible to administer continuous treatment to 
patients who are deemed to be at an adequate risk without 
interruption. It is advisable to solicit expert opinion and 
assistance in each specific case, and whenever practicable, 
patients should be apprised of  the current ambiguity 
surrounding the trade-offs between benefit and risk. The 
physician may recommend a one-year treatment hiatus, 
contingent upon the patient’s circumstances (Hart, 2024).
The study found that bisphosphonates increase the risk of  
atypical femur fractures, thus they must be monitored for 
adverse effects (Bauer et al., 2024). According to the study, 
bisphosphonates, notably alendronate, may raise the risk 
of  rare but severe atypical femoral fractures (Ogundipe, 
2020). Another study examined how bisphosphonate 
cessation affects mineral density and bone turnover (Saag 
et al., 2021). A recent study discovered that the risk of  
fractures increases after the discontinuation of  the drug 
which is the rebound effect. Additionally, it noted the 
overlooked opportunities to prevent fracture fragility 
and deficiency of  osteoporosis treatments (Fuggle et al., 
2021).
This therapeutic gap must be filled by addressing and 
investigating these aspects. Although the efficacy of  
fracture risk reduction of  bisphosphonates is known, the 
potential adverse effects, duration of  therapy, and patient 

demographics must be evaluated to lower atypical femur 
fractures and enhance the efficacy of  the treatment. The 
studies included in this review completely analyse the 
patients’ incidence rates and risk variables of  atypical 
femur fractures. It is crucial to lower the atypical femur 
fractures and enhance overall patient outcomes through 
personalized treatment strategies, immediate adverse 
effect reporting, and regular progress assessments for 
postmenopausal women taking bisphosphonate (Hart, 
2024).

Effects of  Bisphosphonate Treatment Duration and 
Timing of  Initiation
The studies included in this review examine the 
mechanism and treatment duration effects such as 
the bone mineral density modifications after the 
discontinuation of  the treatment and reduction of  
fracture risk to comprehensively understand the safety and 
efficacy of  bisphosphonate therapy in the management 
of  osteoporosis. According to a study, bisphosphonates 
lower the risk of  fractures during the prolonged 
intervention period of  postmenopausal osteoporosis 
(Brown, 2021). Additionally, less atypical femur fractures 
were associated with postmenopausal women taking 
bisphosphonates (Bauer et al., 2024). Another study 
investigated decisions on osteoporosis medication during 
drug discontinuation, highlighting the significance of  
treatment continuation to prevent fractures (Morkos et 
al., 2022). A continued reduction in bone mineral density 
and a temporary increase in bone turnover after a long-
term discontinuation of  bisphosphonate was noted 
(Saag et al., 2021). When bisphosphonate is discontinued, 
an augmented fracture risk and rebound effects are 
developed.

Discussion
Summary of  Key Findings
Researchers selected literature on bisphosphonate-
induced uncommon fractures in postmenopausal women 
to address the first difficulty of  the systematic review 
(Bauer et al., 2024; Ogundipe, 2020). According to a case 
report, extended alendronate use may cause atypical 
femoral fractures, stressing bisphosphonate safety 
regarding the review goals’ risk assessment (Ogundipe, 
2020). The findings underline the need to rapidly detect 
and treat bisphosphonate-induced femur fractures 
(Rudran et al., 2021). The systematic study investigated 
whether continuing bisphosphonate therapy after a 
break increases the incidence of  atypical fractures. This 
systematic review evaluates bisphosphonate duration 
and timing on bone mineral density and fracture risk. 
Bisphosphonates minimize the risk of  fractures (Brown, 



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2021). Studies stress that quitting bisphosphonate therapy 
momentarily stimulates bone turnover and eventually 
reduces bone mineral density (Saag et al., 2021). The 
researcher analyses fracture liaison services and their 
capacity to reduce fracture risk, emphasizing the need for 
healthcare practitioners to adopt preventative measures 
after the holidays despite concerns about bone loss 
after cessation (Toro et al., 2023). The results emphasize 
the need for prescription bisphosphonate therapy for 
fracture prevention and the hazards and benefits of  long-
term usage and drug cessation.

Interpretation of  Findings of  Existing Literature
Researchers demonstrated bisphosphonate medication 
greatly reduces atypical femur fractures (Bauer et al., 
2024; Brown, 2021). Bisphosphonates seldom cause 
these fractures. Scholars educate about bisphosphonate 
medication cessation-induced bone loss and fracture risk 
(Morkos et al., 2022; Saag et al., 2021). A 2020 case report 
describes unanticipated non-traumatic bilateral atypical 
femoral fractures produced by sustained alendronate 
therapy (Ogundipe, 2020). Bisphosphonates reduce 
fracture risk and are safe, therefore atypical femur 
fractures are rare (Bauer et al., 2024; Ogundipe, 2020). 
Patients using the drug long-term should be risk evaluated 
and monitored for adverse effects due to atypical femur 
fracture risk (Ogundipe, 2020). The study found that 
bisphosphonate removal temporarily reduced bone 
mineral density and augmented bone turnover, increasing 
the risk of  atypical fracture (Saag et al., 2021). Atypical 
femur fractures, postmenopausal osteoporosis bone 
health, and bisphosphonate treatment have inconsistent 
outcomes (McKenna et al., 2017). Consequently, this 
study will identify the optimum duration to discontinue 
bisphosphonate after a holiday period without resulting 
in atypical fractures or harming bone health. 

Limitations of  the Evidence
In a retrospective case-cohort study, blinded radiography 
was utilized to analyze bisphosphonate-associated atypical 
femur fractures (Bauer et al., 2024). Bilateral atypical 
femur fractures were reported to be caused by a long-term 
alendronate dosage (Ogundipe, 2020). The case studies 
lack scientific evidence and have low population sizes. 
The clarity and authenticity can be compromised as a 
result of  real-world data analysis potentially complicating 
biases and variables (Morkos et al., 2022). Furthermore, 
biased or confounding references can potentially hinder 
the reliability and validity of  systematic reviews as 
selection bias can falsify or disregard significant research 
dependent on the review criteria. Age, comorbidities, and 
concurrent medications may indicate bisphosphonate-
induced atypical femur fractures, altering relationships. 

Clinical Implications and Future Research 
Directions
A comprehensive examination of  atypical fractures after 
stopping bisphosphonate medication during a holiday 

break reveals clinicians should prioritize bisphosphonate 
therapy for postmenopausal women at risk of  osteoporotic 
fractures. It may reduce fractures with long-term therapy 
(Khan et al., 2022). The potential incidence of  femur 
fractures in patients on bisphosphonate necessitates 
particular attention. Fracture monitoring and evaluation 
are associated with the therapeutic success and safety 
of  the patient. Reinitiating bisphosphonate intake after 
a holiday period necessitates the evaluation of  patient 
risk and following treatment standards. The prevention 
of  fractures must be a regular therapy to lower fractures 
and improve overall patient outcomes. The pros and cons 
of  bisphosphonate therapy should be discussed with the 
patients while following their preferences and values. An 
osteoporosis management strategy highlighting patient 
requirements, providing personalized therapy, and broad 
care may benefit patients with fragility fractures. Further 
research is required to investigate the discontinuation of  
bisphosphonate after a holiday period.

CONCLUSION
Although bisphosphonates reduce the risk of  fractures, 
atypical femur fractures may develop. Therefore, long-
term patient monitoring should be prioritized. Healthcare 
practitioners must keep in consideration the patient’s 
comorbidities, age, and history of  fractures when 
evaluating the benefits and risks of  bisphosphonate 
therapy for the prevention of  fractures. Bisphosphonate 
therapy must be immediately re-initiated after the 
discontinuation of  the medication. The review reported 
that early medication re-initiation augments the risk of  
atypical fractures as a result of  the long-lasting bone 
remodeling effects of  the medication. Thus, personalized 
treatment plans must consist of  the status of  bone 
health and risk profiles to evaluate the bisphosphonate 
re-initiation period and drug interruptions. The use and 
discontinuation of  bisphosphonate requires further long-
term research to a more comprehensive understanding 
of  its long-term outcomes such as the determination 
of  the optimum holiday period and the formulations 
of  bisphosphonate affecting risks of  fractures. Due 
to the limitations of  the present data, further research 
should utilize more rigorous methodological strategies to 
minimize performance and selection biases. Well-designed 
randomized controlled trials with larger sample sizes, 
scientifically evident clinical studies, and comprehensive 
confounding variable information are required to improve 
the bisphosphonate dosage management policies for 
postmenopausal women. Bisphosphonates are crucial for 
the treatment of  postmenopausal osteoporosis. However, 
it should be carefully monitored to evade atypical femur 
fractures. Further research and personalized treatment 
strategies are critical to enhance the overall health 
outcomes for the patients.

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