NICE advises spinal checks at same time as bone density scans in draft guidance

NICE is recommending that a spinal check is added to routine bone density scans under a draft update to its osteoporosis guidance.

 Vertebral fracture assessments should be added to dual energy X ray absorptiometry (DXA) scans in people over the age of 50 years, NICE said.

Evidence shows it is a cost-effective measure to spot hidden fractures as it can be done on the same scanner during the same visit, the committee agreed.

Identifying more vertebral fractures is expected to ‘result in increased and better targeted treatment that will reduce fractures’, the committee added.

The guidance also recommends that DXA scans are automatically offered without the need for a risk assessment tool to people who have had either a previous hip or vertebral fragility fracture, or two or more fragility fractures.

In this group, a risk assessment tool – either FRAX or QFracture – is unnecessary because they will have a risk score of more than 10% anyway, the committee said.

FRAX or QFracture should be used to assess fragility fracture risk in people aged between 50 and 90 years who do not meet this criteria, the guidelines now out for consultation said.

But a full clinical assessment should also be done because the risk tools do not include all the factors that increase the chances of fracture such as medicines that increase the chance of bone loss.

The same risk tool should be used throughout an individual’s care because they calculate risk differently, the recommendations noted.

And it should be taken into account that taking hormone replacement therapy decreases fragility fracture risk while on treatment.

Clinical judgement should be used in assessing risk in those over the age of 90 years, NICE said.

It is thought that osteoporosis affects approximately 3.5 million people in the UK.

Around 70% of spine fractures caused by osteoporosis currently go undiagnosed, NICE noted.

Yet they are common with among the estimated 549,000 new fragility fractures each year, of which 105,000 are hip fractures, 86,000 vertebral fractures, and 358,000 other fractures. 

Last year, the NHS said it was rolling out 13 new DXA bone scanners in hospitals across England, which would have capacity to deliver an extra 29,000 scans per year.

Eric Power, interim director of the centre for guidelines at NICE said: ‘Osteoporosis affects millions in England, and this guidance will help healthcare professionals target care towards those people at highest risk, improving their quality of life while making efficient use of NHS resources.’

The consultation closes on 23 February. Further guidance on osteoporosis treatment, monitoring, and management in specific populations is expected later this year.