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Steroid fractures targeted

Bisphosphonates should be targeted at the half of patients on long-term steroids who are at highest risk of fracture, an NHS analysis concludes.

But the Health Technology Assessment recommends a series of stringent criteria for bone-sparing therapy, which would exclude more than 90 per cent of patients under 50 who take steroids long-term, writes Eleanor Goodman.

The assessment has been submitted to NICE and is likely to help shape NICE guidelines on fracture prevention.

But GPs suggested the recommendations were too restrictive, and that bisphosphonates should be considered in all patients on long-term steroids.

Researchers conducted a systematic review and economic analysis of bisphosphonates for preventing fractures in postmenopausal patients on long-term steroids.

They found it was cost-effective to treat all patients with a prior fragility fracture and all those over the age of 75, irrespective of bone mineral density. But at other ages, treatment was only cost-effective for patients with a T-score of -2.0 SD or less, rendering an estimated 47 per cent of all patients eligible for treatment.

The assessment admitted the strategy would demand DXA scans in 73 per cent of all patients, potentially further stretching services.

Dr Eugene McCloskey, an author of the study and senior lecturer in bone disease at the University of Sheffield, said: 'Steroids have these side-effects and it's up to us to reduce them, but we also have to do that in a finite system of resources.'

But Dr McCloskey added that the cost of bisphosphonates had come down since the analysis was conducted in 2004, and GPs could afford to be more flexible around the edges. He suggested GPs could treat under-75s with a T-score of -1.5 or less while they awaited NICE guidance.

But Dr Brian Crichton, RCGP prescribing advisor, and a GP trainer in Solihull, said he would recommend GPs consider all their patients on oral steroids for drug treatment.

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