The traditional Clinical debate between representatives of ECTS and ASBMR took place on Friday, the 1st of October 2021 and was on the motion: This house believes that intermittent drug holidays are mandatory for long-term bisphosphonate treatment of osteoporosis‘. Interestingly, the ASBMR Program Committee modified this year’s debate format to provide mid-career clinician scientists with the opportunity to actively participate. Thus, the format included two teams (ASBMR vs. ECTS) lead by 1 senior fellow and two mid-career investigators each, and timing included a 20 minute presentation for each team, followed by a panel discussion and rebuttals.
#Team ASBMR comprising Drs. McCloskey, Curtis and Wentworth commented on the unique pharmacological properties of bisphosphonates and their long-term retention in the bone, thus avoiding a rebound phenomenon or an immediate decrease in bone mineral density after their discontinuation. They cited data from randomized control trials and large observational studies to determine the short and long-term bisphosphonate benefits (prevention of fracture) and harms (principally atypical femoral fractures [AFF] and osteonecrosis of the jaw [ONJ]), making the argument for the necessity to implement intermittent drug holidays.
#Team ECTS comprising Drs. Papapoulos, Appelman-Dijkstra and Tsourdi took a different approach. They juxtaposed structured drug holidays as seen in clinical trials where patients have high percentages of adherence to treatment, to real world clinical practice where less structured intermissions of treatment and frequent interruptions of treatment occur, thus leading in a significant increase in fracture risk. In addition, they argued that the majority of patients will never reach treatment targets, now advocated by numerous guidelines and expert opinions, with bisphosphonate monotherapy. They highlighted the rarity of AFF and ONJ as well as the scarce data on how these risks develop after discontinuation of bisphosphonates.
In the end, the devil lied in the detail: #Team ECTS argued that the meaning of the word MANDATORY, translated into ‘obligatory, compulsory, inescapable, unavoidable’ was the key to a very clear voting advice AGAINST the motion. And thus, as the hour in this hybrid debate went past 1am CET, #Team ECTS was successful in swinging the initial percentages and clinched the Golden Femur putting an end to a long wait! Teams parted amicably and the drinks are on #Team ECTS in the next Annual ECTS Conference in Helsinki 2022!
