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NICE osteoporosis guidance is 'unworkable' says GP expert

By Nigel Praities

NICE guidance broadening the range of treatments recommended for osteoporosis has been branded ‘unworkable and unethical' by a leading GP in the field.

The institute was forced to re-consider its controversial decision to only recommend alendronate for both primary and secondary prevention of osteoporosis in post-menopausal women last December, after it was found by its own appeal committee to have ‘behaved unfairly'.

NICE has now decided in two final appraisal determinations to recommend alendronate first-line for primary and secondary prevention of osteoporosis, but other treatments are also recommended in those with higher T-scores and are intolerant or have a contraindication to alendronate.

Under the appraisal determinations, which are currently under consultation, GPs will have to consult complicated T-score tables broken down by age and clinical risk factors, before they are able to recommend other bisphosponates such as risedronate, etidronate and strontium ranelate for primary and secondary prevention of osteoporosis.

Raloxifene is recommended for secondary prevention, but only in those patients intolerant to alendronate and either risedronate or etidronate, and subject to age-adjusted T-scores.

Dr Alun Cooper, GPSI in osteoporosis in Crawley, West Sussex, and chair of the National Osteoporosis Society's primary care forum, said the guidance 'didn't have a hope in hell' of being adopted by GPs as it was so complicated.

‘This is unworkable and unethical. It is not a simple algorithm at all. If someone cannot tolerate alendronate then you are going to have to look at their T-score and say "I'm sorry your bone density is not bad enough to warrant risedronate or strontium,"' he said.

Dr Cooper recommended GPs wait until the publication of the National Osteoporosis Guideline in October, which would recommend using a simple risk score, FRAX, to stratify the treatment of osteoporosis.

NICE has had rocky ride over osteoporosis guidance NICE has had rocky ride over osteoporosis guidance

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