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Institute releases draft osteoporosis rules as study backs BMD screening

By Nerys Hairon

NICE plans to restrict use of bisphosphonates for primary prevention of osteoporotic fractures to women aged 70 or over.

The institute's new draft technology appraisal rules that bisphosphonates are not cost-effective for primary prevention in younger women.

It only sanctions their use in women over 70 with a series of clinical risk factors and low DEXA scan scores.

GPs and osteoporosis experts criticised the appraisal, arguing it was too restrictive and would be ‘shutting the stable door after the horse has bolted'.

The draft appraisal only recommendeds bisphosphonates in women aged 70 to 74 if they have a T-score of -2.5 SD – the threshold for osteoporosis – and three or more clinical risk factors. For patients aged 75 and over with a T-score of -2.5 SD, they must have two risk factors (see box, below).

Dr Jonathan Bayly, an associate lecturer in the osteoporosis programme at the University of Derby, said: ‘I am concerned in primary prevention we are dissuaded from treating anyone below the age of 70.'

Dr Peter Stott, member of the National Osteoporosis Society's scientific advisory committee and a GP in Tadworth, Surrey, said the guidance ‘fails to be sympathetic to the dynamics of osteoporosis'.

‘Someone with a T-score of -2.4 this year may be at -2.8 next year. What is the point of shutting the stable door after the horse has bolted? Whatever happened to clinical acumen?'

Dr Stott added that most pragmatic GPs would treat any patient with a T-score of -2.5 SD or below – with or without risk factors and at any age.

But Dr Mike Harvey, chair of the National Osteoporosis Society's primary care forum and a retired GP, said: ‘It would appear that this is restrictive, but they are including the cost of identifying the patients. They used a QALY of £20,000 instead of £30,000 and under 70 it was found not to be cost-effective.'

NICE's document is be open to consultation until October 21.

nhairon@cmpinformation.com

Bisphosphonates appraisal

Recommended in women aged 70 to 74 with:

•One clinical risk factor and a

T-score of -3.5 SD or below

•Two clinical risk factors and a

T-score of -3 SD or below

•Three or more clinical risk factors and a T-score of -2.5 SD or below

Recommended in women aged

75 and over with:

•One clinical risk factor and a

T-score of -3 SD or below

•Two clinical risk factors and a

T-score of -2.5 SD or below

•Three or more clinical risk factors, without the need for a DEXA scan

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