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Chaos as NICE does U-turn on osteoporosis guidance

The National Institute for Clinical Excellence has been criticised for releasing confusing new guidelines on the secondary prevention of bone fractures in postmenopausal women, after backtracking from its original position.

The institute's initial recommendations on osteoporosis appeared in January and provoked a strong reaction from experts and charities in the field.

In response, the NICE appraisal committee decided to split its guidance on osteoporosis into two separate

appraisals on primary and

secondary preventive treatments.

Dr Peter Stott, a member of the scientific advisory group for the National Osteoporosis Society, said: 'They are making the job of a GP even more impossible.'

The new appraisal consultation document on secondary prevention has recommended the use of the selective oestrogen receptor modulator raloxifene (Evista) as a second-line treatment where bisphosphonates have failed or are contraindicated – in contrast to previous advice that ruled it out.

Bisphosphonates are now indicated for secondary prevention in women over the

age of 75 without the need

for a DEXA scan and for women aged 65-75 if osteoporosis is confirmed by DEXA scanning.

For women younger than 65, bisphosphonates should only be used if the patient is

at a doubled risk of further fragility fractures, according to NICE.

The document also increased the indications for the use of parathyroid hormone (teriparatide) and beefed-up advice on calcium and vitamin D repletion.

Dr Stott, a GP in Tadworth, Surrey, added: 'This guidance is driving everyone to a DEXA scan before you

do anything – it's making the topic very complicated.

'Most GPs' patients have to wait up to 18 months for a DEXA scan – for mine it's a year'.

Recommendations on ost-eoporosis have been under increased scrutiny since the Committee on Safety of Medicines advised against the use of HRT for primary prevention in December last year.

The guidance is due to be finalised in October.

By Rob Finch

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