Whether or not a postmenopausal woman with osteoporosis is offered one of these drugs to prevent bone fractures will depend on her age, her bone density and how many risk factors for fracture and indicators of fragile bones she has.
In principle, alendronate is recommended as a possible treatment for preventing bone fractures in postmenopausal women who have had osteoporosis diagnosed but have not had a fracture.
If a woman can't take alendronate, risedronate and etidronate are recommended under certain circumstances as possible alternative treatments to prevent fractures.
If a woman can't take alendronate or either risedronate or etidronate, then strontium ranelate is recommended under certain circumstances as a possible alternative treatment to prevent fractures.
Raloxifene is not recommended as a treatment for preventing fractures in postmenopausal women with osteoporosis who have not had a fracture.
The guidance says that women who are 75 or over may not need a bone scan to diagnose their osteoporosis.
Update 26 January 2011
NICE has published updated final guidance on preventing osteoporotic fractures following a reconsideration of the use of strontium ranelate for the prevention and treatment of osteoporotic fragility fractures in postmenopausal women.
In accordance with the Court of Appeal’s ruling on the technology appraisals of drugs for the prevention and treatment of osteoporotic fragility fractures in postmenopausal women, NICE asked the manufacturer of strontium ranelate to submit additional evidence. After having examined this additional evidence on strontium ranelate and an independent expert review of the evidence very carefully, the new independent Appraisal Committee reached the same conclusions as the original Appraisal Committee, and so the recommendations on strontium ranelate remain unchanged from those published originally. Consultees then had a chance to appeal against this decision but no appeals were received.
NICE guidance on the use of alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the prevention and treatment of osteoporotic fragility fractures in postmenopausal women therefore remains unchanged.