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.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.