NICE to look again at its osteoporosis rules
By Nerys Hairon
NICE is planning an overhaul of its technology appraisal on the secondary prevention of osteoporotic fractures after research found it was denying treatment to many women with fractures.
The institute has already been forced back to the drawing board on its draft primary prevention appraisal, which the new study also found was excluding significant numbers.
The research found at least one in six women aged 60 to 70 with osteoporosis and a fracture would not be eligible for bisphosphonates under the secondary prevention appraisal.
And as many as three-quarters of women with osteoporosis would not even be diagnosed if, as the institute suggests, osteoporosis was assessed only at the hip and not at the spine.
Researchers also found one in four women aged 60 to 70 referred for DEXA scans would have osteoporosis without being eligible for treatment under the draft primary prevention appraisal.
Study researcher Sue Steel, a consultant physicist at Hull Royal Infirmary, said: 'NICE defines osteoporosis as a BMD T-score of below -2.5 at the hip that disenfranchises a large group who are osteoporotic at the spine.'
NICE said further research had been commissioned on secondary prevention and 'some re-analysis may be required'.
Dr Peter Stott, a member of the National Osteoporosis Society's scientific advisory committee and a GP in Tadworth, Surrey, said: 'This study confirms what practising clinicians have been telling NICE for some time that the NICE guidance is unduly restrictive and will result in many women aged 60-70 who would benefit from treatment not being treated.'
Dr Jonathan Bayly, associate lecturer in the osteoporosis programme at the University of Derby, called the NICE appraisal a 'flawed economic model' for failing to take into account the social care cost of fractures.
He also urged the institute to review its guidance in light of the fact that alendronate had gone generic. 'If the cost of a major drug drops considerably it does make the health economic argument more favourable.'
The study, submitted to the NOS journal Osteoporosis Review, assessed 159 postmenopausal women with fractures, and found 31 per cent had osteoporosis, of which 16 per cent were not eligible for bisphosphonates under NICE because of age restrictions and lack of risk factors.