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NICE recommends new bisphosphonates role

The National Institute for Clinical Excellence is set to recommend the use of bisphos- phonates to treat a million post-menopausal women with severe osteoporosis.

A technology appraisal consultation document released by NICE recommends bisphosphonates (alendronate, etidronate and risedronate) in all post-menopausal women aged 65 and older who have had a fragility fracture, even without a DEXA scan.

Post-menopausal women under 65 would be eligible for the treatment provided a DEXA scan showed they had a T-score below -3.2 SD, or below -2.5 SD and a history of maternal hip fracture or long-term use of systemic steroids.

The extra cost to the NHS in England and Wales is estimated to be £75 million a year.

The guidance warns that before bisphosphonates are prescribed it should be established that the woman has adequate levels of calcium and vitamin D. The advice is in line with the national service framework for older people.

Bisphosphonates are not recommended for any woman who does not have a fragility fracture and raloxifene (Evista) is not recommended for treating osteoporosis in any post-menopausal women.

Teriparatide (Forsteo), an expensive new drug that promotes bone growth, is only recommended for very severe cases.

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