NICE osteoporosis appraisal 'should be redone'
By Nigel Praities
NICE's advice on osteoporosis treatments is ‘unfair, needlessly restrictive and clinically unworkable' and should be done again from scratch, says the National Osteoporosis Society in a letter to the Health Secretary released today.
The strongly-worded letter was sent after an appeal forced NICE to reconsider two controversial final appraisal determinations (FADs) for the primary and secondary prevention of osteoporosis last year.
The revised FADs, released in July, recommend alendronate as first-line therapy, with alternatives only recommended in patients who are intolerant or who have a contraindication to alendronate and if they have significantly worse T-scores.
The National Osteoporosis Society's letter says this is unfair: ‘We question the ethics of a concept where individuals unable to swallow or tolerate alendronate have to get significantly worse than other patients before receiving a treatment that they clearly need,' it reads.
It goes on to say the society had ruled out making another appeal over the appraisal, in favour of asking the Health Secretary to intervene and asking NICE to completely redo its appraisal of osteoporosis treatments.
Dr Sally Hope, a GP in Woodstock, Oxfordshire, who is the RCGP representative working with NICE on the forthcoming osteoporosis clinical guideline, urged GPs to 'go their own way' when implementing the NICE appraisal.
‘I think GPs are wonderfully independent people who will go their own sweet way with this. I would use my clinical judgement and if my patients couldn't tolerate alendronate then I give them something else. I would not deny a treatment to someone just because NICE it was second-line,' she said.Campaigners protest against NICE's decision Campaigners protest against NICE's decision Letter to Health Secretary