GP's near-perfect uptake
NICE has responded to pressure from GPs with new guidance giving the go-ahead to treat women aged 65-74 for osteoporosis without waiting for a DEXA scan.
GPs welcomed the move as 'eminently sensible'. But they criticised the guidance for being too restrictive in younger women, saying the institute was 'setting itself apart from the rest of the world'.
In its final guidance on secondary prevention of osteoporosis, NICE conceded waiting lists for DEXA scans were too long to justify delaying treatment.
Original draft guidance insisted diagnosis should first be confirmed with a T-score of
-2.5 SD or less, although NICE indicated in the summer that it was planning a
NICE said: 'The committee felt that, once booked, a long waiting time for a DEXA scan need not prevent initiation of treatment.
'If appropriate, treatment can be stopped once the
result of the DEXA scan is available.'
Dr Nick Summerton, reader in public health and primary care at the University of Hull and a GP in the city, said NICE should be congratulated for having 'a bit of clinical common-sense', as patients often had to wait six to nine months for a DEXA scan.
But for postmenopausal women under 65 who have suffered a fracture, GPs said the guidance was too restrictive and did not 'bode well' for primary prevention.
NICE told GPs to prescribe bisphosphonates to women under 65 only if they had a DEXA scan score of -3 SD or below, or a score of -2.5 SD or less and a fracture, plus one or more of the additional age-
independent common risk factors (see box).
Dr Iain Gilchrist, a GP in Hatfield Heath in Essex, and a member of the Primary Care Rheumatology Society, said: '[NICE] seems to be deciding to set itself apart from the rest of the world.
'In Europe it's common to start treatment with bone density of -2.5 SD and in the US at -1 SD.'
Dr Peter Stott, a GP in Tadworth, Surrey, and a member of the scientific advisory committee of the National Osteoporosis Society, said GPs would end up treating their pushy patients and not those in lower socioeconomic classes.
NICE technology appraisal on secondary prevention of osteoporosis
Bisphosphonates are recommended as treatment options for:
·Women aged 75 and over with no need for DEXA scanning
·Women aged 65 to 74 who are referred for a DEXA scan, and when DEXA scan
·Postmenopausal women under 65 with a T-score of -3 SD or below
·Postmenopausal women with a T score -2.5 SD or below with a fracture
plus one or more age-independent risk factors, such as low body mass
index or family history
By Nerys Hairon