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Study casts doubt on NICE DEXA scan rules as GP unease grows

The National Institute for Clinical Excellence has come under renewed fire for its controversial osteoporosis guidance, after a study undermined one of its key recommendations.

New research in the Archives of Internal Medicine (May 24) has cast doubt on the predictive value of DEXA scanning, which NICE says all women under 75 should have before receiving treatment.

NICE's final draft appraisal on the secondary prevention of osteoporosis is underpinned by WHO guidelines on DEXA scanning, stating that bone mineral density T scores of

-2.5SDs or less are indicative of osteoporosis.

Yet the new study of 149,524 postmenopausal wo-men found only 6.4 per cent of fracture sufferers had previously recorded a T score of

-2.5SD or less.

The study authors argue the existing thresholds for treatment should be lowered and other risk factors considered.

The study was published as a survey revealed that two-thirds of GPs had patients who had suffered fractures while waiting for a DEXA scan.

Survey leader Dr Nick Summerton, head of primary care at the University of Hull and a GP in the city, demanded a more flexible approach from NICE. He said: 'NICE doesn't really understand the primary care context.

'They are deciding somewhat arbitrarily when to initiate treatment.

'As a GP I would use my clinical judgment, and for secondary prevention get them on treatment and scan when you can.

'DEXA should be an aspiration, not a requirement for treatment.'

Of 200 GPs questioned in the survey, 94 per cent said their patients would wait more than a month for a DEXA scan.

According to the draft NICE document, the cost of treating osteoporotic fractures in postmenopausal women was £1.5 billion to £1.8 billion in 2000.

NICE is scheduled to publish its full appraisal in

October.

By Rob Finch

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