NICE issues guidance on drugs for osteoporosis
More osteoporotic fractures may be prevented by wider use of drugs |
Guidance (PDF 260K) on the use of bisphosphonates, raloxifene and teriparatide
for the secondary prevention of osteoporotic fragility fractures in postmenopausal
women has been issued this week by the National Institute for Clinical
Excellence.
The guidance refers to treatment of postmenopausal women who have normal
calcium and/or vitamin levels and does not cover treatment of corticosteroid-induced
osteoporosis.
It recommends that the bisphosphonates alendronate (Fosamax), etidronate
(Didronel) and risendronate (Actonel) be used for the secondary prevention
of osteoporotic fractures in the following groups of women:
· Women aged 65–74 years if osteoporosis is confirmed by dual
energy X-ray absorptiometry (DEXA) scanning
· Women aged 75 years and older without the need for DEXA scanning
· Postmenopausal women younger than 65 years old with a very low bone
mineral density or confirmed osteoporosis plus an additional age-independent
risk factor
Regarding choice of bisphosphonates, the guidance says that health professionals
and patients need to balance the drug’s proven
effectiveness profile against tolerability and adverse effects.
NICE says that the selective oestrogen receptor modulator raloxifene
(Evista) is recommended as an alternative treatment option in women for
whom bisphosphonates are contraindicated or not tolerated, those who
have not responded to bisphosphonates and those who are physically unable
to comply with the recommendations for use of the drugs.
NICE now recommends that teriparatide (Forsteo) should be used as a treatment
option for secondary prevention of osteoporotic fractures in women aged
over 65 years of age who have had an unsatisfactory response to or intolerance
to bisphosphonates and either an extremely low bone mineral density or
a very low bone mineral density, multiple fractures plus an additional
risk factor.
NICE adds that it is not possible to provide precise data on the overall
impact of this guidance on NHS prescribing costs, but acknowledges that
it is possible that it will increase the use of bisphosphonates in women
with osteoporotic fragility fractures and increase the demand for DEXA
scanning.
NICE guidance on the use of bisphosphonates and raloxifene for the primary
prevention of osteoporotic fractures in postmenopausal women is also
in the pipeline,
although a publication date is not yet available. Guidance on the prevention
of osteoporotic fractures in individuals at high risk and the use of
strontium ranelate for the prevention of fractures is expected in February
2006 and March 2006, respectively. |
The
Pharmaceutical Journal
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