| Fracture risk | Assessment | Recommendation/comment |
| High (> 20% 10-year risk of fracture), Previous fragility fracture and FN still T-score ≤ −2.5 | NA | Drug holiday not justified, Continue bisphosphonate therapy or switch to another proven drug such as teriparatide or denosumab |
| Moderate (1% - 20% 10-year risk of fracture), FN now (T-score > −2.5), and no previous history of fragility fracture | • Assess clinical risk factors for fracture • Assess FN BMD • Request lateral spine X-ray scan to investigate for any subclinical vertebral fractures | • May be candidate for drug holiday • If vertebral fractures are found, stratify patient as high risk and continue bisphosphonate therapy • If there is no previous history of fragility fracture, a drug holiday can be considered if FN BMD T-score is > −2.5 and there are no other important clinical risk factors Restart when indications for therapy are met |
| Low (<10% 10-year risk of fracture), Did not meet current treatment criteria at the time of treatment initiation | • No important clinical risk factors for fracture | At low future fracture risk, should be withdrawn from therapy • Monitor at extended intervals (3 - 5 years) |