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Bone drugs policy will hit patients

Regarding your article 'Bone drugs for all ages' (News, 5 July), reporting the NICE final appraisal determination (FAD) of treatments for primary and secondary prevention of osteoporotic fractures in postmenopausal women.

The way NICE has changed the risk factors since the previous draft means many younger women who are at a higher risk of fracture will still not be eligible for treatment.

The article reports the lifting of restrictions on younger patients requiring drug therapy for primary prevention, but this fails to recognise that additional complicated risk factor assessment has been inserted. In addition, the article does not address another critical failing: the appraisal recommends only one drug (alendronate) for the three million people at risk of osteoporotic fracture in the UK, despite its non-suitability for up to a quarter of all patients.

The appraisal committee was due to consider other treatments (etidronate, risedronate, raloxifene, strontium ranelate and teriparatide) as well as alendronate, but has opted for a 'one treatment for all' policy. While the other five treatments may be covered by the NICE clinical guidelines on osteoporosis due later this year, these will not be mandatory, so health services will be reluctant to fund prescriptions other than alendronate.

The society will appeal against the FAD because it fails to provide treatment options for patients who are either intolerant of alendronate or contraindicated.

From David M Reid, chair of the medical board, National Osteoporosis Society

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