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GP prescribing curbs lifted by NICE U-turn on osteoporosis

Stringent limits on the drugs GPs can use to prevent and treat osteoporosis may be relaxed after the National Institute for Clinical Excellence bowed to pressure to re-evaluate its draft appraisal of the condition.

NICE recommended curbs on GP prescribing of bisphosphonate, raloxifene and para-thyroid hormone in December last year. But in a statement issued last week the institute said it had decided to subdivide the appraisal in order to examine the issues of prevention and treatment separately and analyse new information on preventive treatments more closely.

NICE said it had received a large amount of information during consultation and that it wanted to delay its appraisal until April, while it considered the new information.

NICE's preliminary recommendations were that bisphosphonates should only be prescribed for over-65s with a fragility fracture or under-65s with fragility fractures and a low DEXA scan score or a history of steroid use or maternal hip fractures.

The committee also recommended against the use of the selective oestrogen receptor modulator raloxifene and that parathyroid hormone should only be used in very severe cases of osteoporosis where bisphosphonates have been inadequate.

Dr Peter Stott, a GP in Tadworth, Surrey, and a member of the scientific advisory group of the National Osteoporosis Society, said: 'The society's position is that we are very afraid women who are at significant risk of osteoporosis after the menopause will have no treatment available.

'If you have a blanket ban on HRT there needs to be something in its place, otherwise you are saying that prevention of osteoporosis is not worth it.

'From our point of view, prevention works.'

Dr Stott added that NICE was 'a source of good, solid advice' at the population level, but that GPs on the frontline needed to make treatment choices based on individual circumstances that may be extreme, for instance, where patients could not tolerate certain treatments.

A National Osteoporosis Society spokesperson welcomed the U-turn, saying 'NICE should be praised for listening', but added that the charity still had concerns that treatment options were too restrictive for patients with osteoporotic fractures.

By Rob Finch

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