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Government backs rival to NICE guidance on fracture risk

By Nigel Praities

Department of Health guidance has endorsed a rival tool for use alongside NICE guidelines to assess fracture risk in older people in primary care.

The DH's best practice guidelines for the NHS recommend the FRAX tool – developed by the World Health Organisation – is used to identify patients who need preventative treatment for osteoporosis.

NICE rejected the FRAX tool in its controversial technology appraisals issued last year, saying a combination of T-scores, age and risk factors was ‘more appropriate' for assessing eligibility for treatment.

This guidance met with considerable opposition from GPs and specialists, with 10 medical organisations releasing alternative National Osteoporosis Group (NOGG) guidelines for GPs endorsing the use of FRAX.

The new 'prevention package' to improve NHS services for older people recommends primary care-based fracture liaison programmes are set up, where specialist GPs and nurses case find patients with fragility fractures and identify high-risk patients using FRAX.

‘Using primary care records and the FRAX osteoporosis risk assessment tool, the service can proactively identify people whose fragility fractures have not previously been assessed, and other patients at high risk of primary fractures,' says the guidance.

The DH advice follows recent research showing the FRAX risk assessment tool results in treatment costs that fall ‘comfortably' within cost-effectiveness thresholds set by NICE.

Nick Rijke, director of public and external affairs at the National Osteoporosis Society welcomed the new guidance, saying: ‘Fragile bones are being taken seriously at long last and we now have real prospects of reducing the extraordinary number of people who fall and break hips every year.

‘The acid test though will be in local health trusts and hospitals taking this on board and making sure they provide the range of services that will make a real difference.'

The National Osteoporosis Society has campaigned for the use of the FRAX tool

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