Impact of Bisphosphonate Discontinuation on Bone Density, Turnover, and Fracture Risk in Children With Osteogenesis Imperfecta: A Literature Review

Bisphosphonate therapy is effective at increasing Bone Mineral Density (BMD) and decreasing fractures in children with Osteogenesis Imperfecta (OI), but long-term use has the potential to cause bone remodeling oversuppression. Drug holidays are proposed as a strategy to balance these benefits and risks. This study aimed to analyze the safety and efficacy of drugs holidays in children with OI through literature review conducted systematically on PubMed, Scopus, and Science Direct for publications in 2000-2025. Of the 423 articles identified, 9 studies met the inclusion criteria and were analyzed based on changes in BMD, Bone Turnover Markers (BTM), as well as fracture incidence. The majority of studies show that drug holidays do not increase the incidence of fractures and are able to maintain BMD, especially in children approaching the end of growth. However, a small percentage of studies report a decrease in BMD or an increase in BTM in patients who are still in the active growth phase. Overall, a drug holiday can be a safe strategy in patients with well-reacted therapies and a steady increase in BMD, with regular monitoring to determine retreatment needs and ensure long-term safety.