New osteoporosis guidance means thousands more could receive drugs

Updated NICE guidelines on osteoporosis recommend that the initiation of treatment should be linked to the person’s risk of developing a bone fracture, dependent on cost-effectiveness.

Professor Carole Longson MBE, director of the centre for health technology evaluation at NICE, said: “It will provide clarity for health professionals about when to start treatment with bisphosphonates and it will provide people who have osteoporosis with access to the most cost-effective treatments to prevent them getting a fracture.”

The guidance recommends that oral bisphosphonate drugs alendronic acid, ibandronic acid and risedronate sodium should be considered in people that have at least a 1% risk of developing a bone fracture in the next 10 years, whilst injected bisphosphonates ibandronic acid and zoledronic acid should be considered in people that have at least a 10% risk of developing a fracture in the next 10 years. In those patients that have a 1% risk or more, but are contraindicated or intolerant to oral bisphosphonates, then injectable bisphosphonates are recommended instead.

Clinicians should use either the FRAX or QFracture risk-assessment tools to estimate a person’s 10-year probability of developing osteoporosis. Risk factors associated with developing osteoporosis include: increasing age (over 65 for women, over 75 for men), smoking, a history of falls, low body mass (<18.5 kg/m2), previous bone fractures, a family history of hip fractures, and alcohol intake (more than 21 units per week for men, and 14 units for women). The menopause is also associated with an accelerated bone loss and women are at a greater risk than men of developing osteoporosis, with one in three women compared to one in five men suffering a fragility fracture in their lifetime.

The current annual cost to the NHS in the treatment of osteoporosis is estimated at £1.73 billion, with more than 300,000 people seen in UK hospitals because of fractures as a result of osteoporosis. This figure is set to rapidly increase in future years due to the growing ageing population.

The National Osteoporosis Guideline Group (NOGG) and SIGN also offer their own guidance on the treatment of osteoporosis, which sometimes differs to that provided by NICE. 

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