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NHS report backs HRT for osteoporosis in all over-50s

GPs should prescribe HRT and calcium plus vitamin D from age 50 in all suitable women with osteoporosis to prevent fractures, according to an influential Government-commissioned report.

The NHS Health Technology Assessment will inform guidance on osteoporosis due from the National Institute

for Clinical Excellence this


Fracture risk was calculated from bone mineral density measurements and costs were determined by a systematic

literature review. Treatment cost-effectiveness was then graded for patients aged 50, 60, 70 and 80.

Oestrogen-only and oestrogen-like HRT were cost-

effective from age 50 to 60 ­ and above when appendicular fractures were included.

Calcium was cost-effective from age 60 in preventing

vertebral fractures and at all ages when appendicular fractures were considered. Bisphosphonates were cost-effective from the same age, apart from alendronate (Fosamax), which was not cost-effective until age 70.

The vitamin D derivative

alfacalcidol ­ not licensed for osteoporosis ­ was also cost-effective from age 70. But raloxifene (Evista) only became cost-effective at 70 after taking account of cardiovascular benefits. Calcitonin was not cost-effective at any age.

The study used a cost-effectiveness threshold of £30,000 per quality-adjusted life year gained, the same as that used by NICE.

Study leader Professor John Kanis, director of the World Health Organisation collaborating centre for metabolic bone disease in Sheffield, said the findings were a 'direct message' to policymakers: 'There are cost-effective scenarios to be found.'

Dr Mike Harvey, chair of the National Osteoporosis Society primary care forum and a GP in Cuckfield, West Sussex, said the results were a useful reminder of the cost-effectiveness of treating older patients. He urged GPs to assess the risk of falls and fractures in all over-75 checks.

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