NICE continues to recommend the use of alendronate as the first-line treatment, despite concerns over tolerability.
Following its guidance, patients must wait for their condition to worsen and show deterioration in T-scores before they can be switched to risedronate or etidronate.
NICE also rules out using the FRAX tool, recommended in the National Osteoporosis Guideline Group (NOGG) advice, for evaluating fracture risk. Its appraisal committee did not accept that treatment advice should be based on absolute risk as calculated by FRAX.
The committee also did not agree that all clinical risk factors in FRAX were appropriate.
Dr Alun Cooper, chairman of the National Osteoporosis Society's primary care forum, described the NICE appraisals as 'unworkable' and 'unethical'.
'NICE has ignored the use of FRAX, osteoporosis risk in men and steroid use in its appraisals.
'GPs should go with the NOGG guidelines, which are very user-friendly, and use common sense.'
Oxford GP Dr Sally Hope, an RCGP representative on the NICE osteoporosis guideline group, added: 'I would strongly recommend that GPs look at the NOGG guidelines.
'They are the most up to date, and recommend FRAX, which allows GPs to assess patients' individual fracture risk.'
See also: Assessing fracture risk in osteoporosis