Even patients with low fracture risk benefit from bisphosphonates, NICE says

Osteoporosis patients with a risk of fracture above 1% could benefit from bisphosphonates, NICE has said, but charities have called for GPs to be given more guidance on prescribing.

Bisphosphonates are cost effective even in people with very low risk of fracture, NICE has concluded in its latest technology appraisal.

Oral bisphosphonates should be considered to treat osteoporosis in adults with a 10-year probability of related fracture as low as 1% – as according to the FRAX or QFracture risk tools, it said.

Intravenous bisphosphonates are recommended if risk of fracture is above 10%, or if a patient with a risk over 1% cannot take or tolerate the oral version.

It adds that the choice of treatment should be made on an individual basis after a discussion between the responsible clinician and the patient.

Bisphosphonates – including alendronic acid, risedronate, ibandronate and zoledronic acid – are the most common group of drugs used to treat osteoporosis.

Fracture risk

The revamped recommendations apply to men as well as women, and come in light of a new meta-analysis confirming that bisphosphonates are more effective at reducing the risk of fracture compared to placebo.

The National Osteoporosis Society warned GPs that – although the drugs are clinically and cost effective – they may not be appropriate for every patient with a low fracture risk.

‘There is a risk that if the [technology appraisal] is not correctly applied people could receive a treatment when they don’t need one,’ it said.

‘With growing concerns about possible rare long-term effects of bisphosphonate treatments, we want to make sure that people are only given a treatment when the benefits of treatment outweigh the risks.

‘Health professionals, especially non-specialists like GPs, may need some additional guidance to support their decisions about which patients should be offered a bisphosphonate.’

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