NI Guidelines Ration Affordable Osteoporosis Drugs

Low cost osteoporosis drugs are strictly rationed for the under 75s, and UK physicians hampered by restrictive guidelines, according to findings which appear in the journal Therapeutic Advances in usculoskeletal Disease, published by SAG A leading ambridge University bone health expert has outlined flaws in NI osteoporosis treatment guidance, which limits options for many postmenopausal women in the under-75 age bracket

According to ambridge University Professor of Bone edicine, Juliet ompston, the current UK guidelines are unnecessarily complex Physicians following the guidelines treat postmenopausal women aged over 75 with low trauma fractures known as fragility fractures with alendronate This drug prevents further bone weakening by preventing the loss of bone that occurs with ageing

However, physicians treating postmenopausal women under 75 with similar fractures have to demonstrate that the patient has bones scoring 25 or less on the ‘T-score,’ a measure of bone mass, to prescribe alendronate There are alternatives for those who cannot take alendronate etidronate, risedronate, or strontium ranelate or, for secondary prevention only, raloxifene but a prescription for one of these often requires even more stringent criteria

Alendronate, the first line of treatment, is available as a ‘generic’ drug and costs less than £20 per year to prescribe With the second raft of treatments costing £350 per year or less, physicians are faced with a difficult ethical dilemma in patients who are intolerant to alendronate as they know that these treatments are effective, yet they often cannot prescribe them until the patient has lost more bone This is particularly unfortunate since intolerance to alendronate is common in frail elderly women, who are at very high risk of suffering further fractures

There are no current NI guidelines for treating men with fractures, or either men or women treated with glucocorticoids, which are a common cause of osteoporosis Without NI guidelines, cash-strapped primary care organisations may chose not to extend treatment to these individuals

Osteoporosis leads to over 1000 deaths each month in the UK alone from hip fractures, and costs the National Health Service NHS and UK government £23 billion each year, according to figures from the National Osteoporosis Society charity Factors such as drinking three or more units of alcohol per day, a family history of osteoporosis and long-term rheumatoid arthritis are among those that can increase fracture risk

The National Osteoporosis Guideline Group NOGG has produced alternative guidelines, using different criteria to NI Recent national guidelines from other countries are more in keeping with NOGG, which takes independent clinical risk factors into account for fracture prediction and uses the WHO-supported FRAX® fracture risk algorithm The NOGG approach to second-line therapy also eliminates the additional criteria for those unable to tolerate alendronate

NI is an independent organisation, which produces guidance in several areas including NHS drug prescriptions, which in general the NHS has to adhere to Although NI guidelines are often key to ensuring the best and most cost-effective treatments, the technology appraisals for osteoporosis have “fallen below the normally high standards of NI, resulting in outdated and inappropriately restrictive guidance,” ompston argues, adding that when it comes to osteoporosis, “the fundamental principles of consistent use of the evidence base, transparency, and equity across disease states have not been observed”

ompston calls for a fresh NI appraisal of osteoporosis treatments A new appraisal may also benefit those beyond the UK many other countries look to NI guidelines as a template for their own national guidelines

Source: SAG Publications

source : www.medicalnewstoday.com

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