Under the latest revision of the guidelines, which have been in development for the past five years, treatment with alendronate can be initiated in women over 70 if they have one clinical risk factor and a T score below –2.5 SD.
For secondary prevention, alendronate can be initiated in all postmenopausal women who have a T score below –2.5 SD.
Hertfordshire GP Professor Mike Kirby, who has an interest in osteoporosis, said: ‘We shouldn’t be waiting for people to have fractures. We know one fracture doubles the risk of another.’
Where available, dual energy X-ray absorptiometry (DXA) should be commissioned to stratify osteoporosis patients into high, medium and low risk, he said.
High-risk patients could be given treatment and those at medium risk could be given lifestyle advice.
Professor David Reid, a consultant in Aberdeen and chairman of the medical board at the National Osteoporosis Society, said even without a DXA scan, it will be evident which patients are at high risk of fracture.
‘NICE says don’t treat patients who have osteoporosis and could be at high risk, even if under 70,
so I suspect NICE will face some legal challenges,’ he said.