LONDON -- October 27, 2008 -- The National Institute for Health and Clinical Excellence (NICE) has published final guidance on the use of drugs to prevent osteoporotic fractures in postmenopausal women.
The final guidance recommends access for postmenopausal women to a range of treatments for both primary prevention and secondary prevention. This includes options for women who are contraindicated to or intolerant of the recommended initial treatment, based on specified clinical criteria.
"These 2 new pieces of guidance will provide postmenopausal women with consistent access to the most cost-effective treatments to either prevent a first osteoporotic fracture or to help stop an osteoporotic fracture from happening again," said coauthor Peter Littlejohns, NICE, London, United Kingdom.
The guidance on secondary prevention recommends wider access to alendronate and now covers all postmenopausal women with confirmed osteoporosis, regardless of age. Alternative effective treatments are also recommended for women who cannot take alendronate.
The guidance on primary prevention recommends alendronate as a treatment option for primary prevention of osteoporotic fragility fractures in women aged 70 years or older who have an independent clinical risk factor for fracture or an indicator of low bone mineral density (BMD) and are confirmed to have osteoporosis.
In women aged 75 years or older who have 2 or more independent risk factors for fracture or low BMD, a DXA scan may not be required if the responsible clinician considers it to be clinically inappropriate or unfeasible.
Alendronate is also recommended for primary prevention of osteoporotic fragility fractures in postmenopausal women younger than 70 years who have confirmed osteoporosis and:
· An independent clinical risk factor for fracture for those aged 65 to 69 years
· An independent clinical risk factor for fracture and at least one additional indicator of low BMD for those aged younger than 65 years.
For women who are contraindicated to or intolerant of alendronate, or cannot comply with the special instructions for its administration, risedronate and etidronate are recommended alternative options.
Strontium ranelate is a recommended alternative treatment option for women who are contraindicated to, or intolerant of alendronate, risedronate and etidronate, or cannot comply with the special instructions for their administration. Raloxifene is not recommended as a treatment option for primary prevention of osteoporotic fragility fractures.
For secondary prevention of osteoporotic fragility fractures, alendronate is recommended in all postmenopausal women who have confirmed osteoporosis. Women aged 75 years or older may not need a DXA scan if their doctor considers a DXA scan to be clinically inappropriate.
For women who cannot take alendronate, risedronate and etidronate are recommended options based on a specified combination of age, T-score and number of independent clinical risk factors. For women who cannot take alendronate, risedronate and etidronate, strontium ranelate and raloxifene are recommended options based on a specified combination of age, T-score and number of independent clinical risk factors.
Teriparatide is a recommended alternative option, based on a specified combination of age, T-score and number of independent clinical risk factors, for women who can't take any of the previous recommended options or who've had an unsatisfactory response to alendronate, risedronate or etidronate.
Women who are currently receiving either primary or secondary prevention treatment with 1 of the drugs covered by this guidance, but for whom treatment would not have been recommended according to either piece of guidance, should have the option to continue treatment until they and their doctors consider it appropriate to stop.
SOURCE: The National Institute for Health and Clinical Excellence
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