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Gold, incentives and meh

Bone drugs for all ages

NICE has scrapped its controversial age limits on osteoporosis treatment in last-minute changes to its primary prevention guidance.

The institute caved in to pressure from the RCGP and National Osteoporosis Society and removed the requirement for women without a previous fracture to be over 70 before being eligible for drug therapy.

The final appraisal determination – covering both primary and secondary prevention – looks set to end an embarrassing saga for the institute, which included age restrictions in a series of earlier drafts.

Professor Peter Littlejohns, clinical and public health director of NICE, insisted: 'This new draft takes into consideration the comments received and makes it easier for postmenopausal women to start treatment to prevent a first osteoporotic fracture or stop a fracture happening again.

'It widens access to primary prevention treatment to postmenopausal women aged under 70 with clinical criteria indicating low bone mineral density and increased fracture risk.'

But some GPs remained dissatisfied, warning younger women would still need to jump through 'ridiculous hoops' before being treated.

The guidelines propose treatment with alendronate for postmenopausal women who are under 70 only if they have medical conditions suggestive of low BMD and at least one other clinical factor suggestive of increased fracture risk, and a T-score of -2.5 SD or below.

Dr Jonathan Bayly, a member of the scientific advisory group of the NOS, said a patient did not need to have both factors to be at risk.

'I welcome the fact it allows us to treat younger patients but I still have major concerns. If you can think in 10 nanoseconds of something that makes the guidelines seem ridiculous, they need looking at again.'

Dr Brian Crichton, a GP in Solihull, West Midlands, and honorary professor in therapeutics and pharmacology at the University of Warwick, said the guidance was a step in the right direction: 'It offers the chance to capture more people under 70, but it is still very complicated.'

The guidelines for secondary prevention remain the same as the previous draft. Treatment with alendronate is recommended in all postmenopausal women who have a T-score of -2.5 SD or below.

The NOS has submitted an appeal against the document, ahead of final guidance expected in August.

Final osteoporosis appraisal


• Alendronate for initiation of primary prevention

• Women aged 70 or older with one or more factors suggestive of increased fracture risk or medical conditions suggestive of low BMD and T-score of -2.5 SD or below recommended for treatment

• Women aged 75 years or older with two or more risk factors may not need a DXA scan

• Women under 70 to get treatment where medical conditions suggest low BMD and at least one other clinical factor suggests increased fracture risk, where T-score is -2.5 SD or below


• No age limit

• Alendronate recommended for initiation of therapy

• All women with a T-score of -2.5 SD or below confirmed by DXA scanning

• Women aged 75 or older may not need a DXA scan

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