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Gold, incentives and meh

NICE U-turn throws open access to osteoporosis drugs

NICE has flung open the door to treatment for many thousands more patients with osteoporosis under dramatically revised proposals.

Its new recommendations are a sharp U-turn, removing the most severe of the original age restrictions while aiming

to relieve pressure on overstretched DXA scan services.

The institute had been forced back to the drawing board after a barrage of criticism from clinical groups over its original plans on primary and secondary prevention.

Professor Peter Littlejohns, clinical and public health director of NICE, said: 'The new draft recommendations make it easier for postmenopausal women to receive treatment.'

The new draft guidance was welcomed by GPs, but the National Osteoporosis Society (NOS) said it still had 'serious concerns' that younger women would miss out on treatment.

Under the guidance, the minimum age threshold for primary prevention treatment has been dropped from 75 to 70. NICE now recommends alendronate for women 70 or over with one or more risk factors and a T score of -2.5 SD or below.

DXA scans no longer need to be used in all cases, with women 75 or older with two or more risk factors only requiring one if the GP deems it 'clinically appropriate'.

GPs had argued the original guidance was overly restrictive and would send DXA scans soaring to unmanageable levels.

Dr Peter Stott, a member of NOS, said that there had been 'immense pressure' on NICE.

Dr Stott, a GP in Tadworth, Surrey, said: 'When the initial guidelines came out they were too strict. We'd all welcome the fact that more women can get treatment.'

Pressure is now growing for osteoporosis to be added to the quality and outcomes framework, with the NOS submitting proposals based on a pilot scheme in the Isle of Man.

Professor Mayur Lakhani, chair of the RCGP, said osteoporosis was a disease 'that deserves more consideration'. He said: 'It has been the Cinderella of chronic disease.'

Draft secondary prevention guidance recommends alen- dronate for all postmenopausal women with a T-score of -2.5 or below. But Dr Lakhani warned that even with the rules on DXA use being relaxed, provision was inadequate.

• Comment, page 00

Revised NICE draft guidance

Primary prevention

• Alendronate for initiation of primary prevention

• Women aged 70 years or older with one or more clinical risk factors and T-score of 2.5 SD or below are recommended for treatment

• Women 75 years or older with two or more risk factors may not need a DXA scan

secondary prevention

• No age limit

• Alendronate is recommended for the initiation of therapy

• All women with a T-score of 2.5 SD or below confirmed by DXA scanning

• Women aged 75 years or older may not need a DXA scan

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