Guidelines on osteoporosis 'harm half of elderly women'

23 Jul 09

The group of Scottish consultants say the guidelines encourage GPs to prescribe alendronate to women aged over 75, over half of whom will gain no benefit from the therapy and will be needlessly exposed to potential side-effects.

NICE guidelines on the primary prevention of osteoporosis says a diagnosis of osteoporosis can be 'assumed' in women aged 75 years or older with a fragility fracture and preventative treatment can be prescribed without any further investigations, such as a DXA scan.

The guidelines were met with considerable opposition from experts and GPs when they were published last year, but have since been used as the basis for an enhanced service agreement for practices.

The majority of women receive alendronate, but the researchers – writing in the BMJ – argue that only 50% of older women have osteoporosis and there is no evidence that the other 50% benefit from alendronate treatment.

The researchers conducted an audit of women aged 75 years or older with fragility fractures at the Lothian and Glasgow fracture liaison services in 2007.

They found only half of the 1,000 women analysed had osteoporosis, 37% had evidence of osteopenia and 13% had normal T-scores.

Professor Stuart Ralston, lead author and professor of rheumatology at the University of Edinburgh, said alendronate was not effective in osteopenia and GPs should be referring all women for DEXA scanning no matter what age.

‘The basic principle of medical care is to give treatment only when the benefit outweighs the risk.

'If GPs adhere to the direct enhanced service agreement , around half of elderly women will be prescribed drugs which in any cases will cause harm and for which evidence against fracture is lacking,’ he said.