NICE issues recommendations on bisphosphonates for treating osteoporosis

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Takeaway

  • National Institute for Health and Care Excellence (NICE) has issued evidence-based recommendations on the bisphosphonates alendronic acid, ibandronic acid, risedronate sodium and zoledronic acid for treating osteoporosis.

Key recommendations

  • In adults, oral bisphosphonates (alendronic acid, ibandronic acid, and risedronate sodium) should be recommended as options for treatment of osteoporosis only if:

           —    The person is eligible for risk assessment as defined in NICE's guideline on osteoporosis.

           —    The 10‑y probability of osteoporotic fragility fracture is at least 1%.

  • In adults, intravenous bisphosphonates (ibandronic acid and zoledronic acid) should be recommended as options for treating osteoporosis only if:

           —    The 10‑y probability of osteoporotic fragility fracture is at least 10%.

          —     The 10‑y probability of osteoporotic fragility fracture is at least 1% and oral bisphosphonates (alendronic acid, ibandronic acid or risedronate sodium) are contraindicated or not tolerated in a person.

  • In line with NICE’s guideline on osteoporosis, 10‑y probability of osteoporotic fragility fracture should be estimated using the FRAX or QFracture risk tools.
  • Treatment choice should be made on an individual basis. If generic products are available, the least expensive formulation should be started taking into account administration costs, the dose needed and the cost per dose.