NICE Technology appraisal on bisphosphonates for osteoporosis
10 Jul 2017
On 10 July 2017, NICE issued a new Technology Appraisal (TA) for bisphosphonates which links the recommendations for drug treatments to advice on fracture risk assessment outlined in their earlier guidance[i].
The TA is not intended to provide treatment thresholds but offers recommendations on cost-effective use of bisphosphonates when using fracture risk assessment as described in their guideline [hyperlink to CG146].
For the first time, these recommendations will apply to men as well as women.
The TA says that provided an individual meets the criteria for fracture risk assessment there should be no financial barrier to them receiving bisphosphonates if they have a fracture risk of at least 1% using FRAX or QFracture. If that person does not get on with an oral treatment, intravenous (IV) bisphosphonates can be given instead.
If a doctor wants to prescribe IV bisphosphonates without first trying an oral treatment, their fracture risk needs to be at least 10% using FRAX or QFracture.
Non-bisphosphonate treatments for osteoporosis will be reviewed by NICE in a separate piece of work which has not yet begun.
The NHS is legally obliged to fund treatments recommended by NICE's technology appraisals – patients now have the right to these treatments, if their doctor believes they are clinically appropriate.
Health professionals will be required to make treatment decisions in a landscape with contradicting clinical guidance. For those who use the online tool FRAX to assess risk, NICE have signposted NOGG for more information about appropriate treatment thresholds. The SIGN guideline on osteoporosis applies in Scotland and also offers sensible, evidence based recommendations.
 NICE Clinical Guideline 146: Assessing the risk of fragility fracture. 2012