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Bisphosphonates are the most widely used anti-resorptive, reducing bone turnover markers to low premenopausal concentrations and reducing fracture rates (vertebral by 50–70%, non-vertebral by 20–30%, and hip by ~40%).
Bisphosphonates bind avidly to bone mineral and have an offset of effect measured in months to years.
Long-term, continuous use of oral bisphosphonates is usually interspersed with drug holidays of 1–2 years to minimize the risk of atypical femoral fractures.
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