A draft appraisal document issued by NICE now recommends second-line use of risedronate and etidronate in primary and secondary prevention of fractures.
The move follows concerns that GPs are being forced by PCTs to prescribe alendronate to patients with osteoporosis, despite one in four patients being unable to tolerate the drug, following NICE's announcement in June to only prescribe alendronate.
But the draft appraisal guidance from NICE now states that risedronate and etidronate can be used by women who cannot tolerate alendronate, subject to T-scores.
Prof David Reid, chairman of the National Osteoporosis Society medical board, said: ‘It is good news that NICE recognises that there is more than one drug out there for the treatment of osteoporosis, especially as many patients cannot tolerate alendronate.
However, he added: ‘Using T-scores to decide which treatment a patient should be given is clinically unworkable.'
Strontium ranelate is also recommended as an alternative treatment for women who cannot tolerate alendronate and risedronate, says NICE.