Quality statement 4: Long-term follow-up

Quality statement

Adults having long-term bisphosphonate therapy have a review of the need for continuing treatment.

Rationale

The optimal duration of bisphosphonate therapy is unclear and there are possible adverse effects of long-term treatment. A medication review for people having long-term bisphosphonate therapy gives the opportunity to consider whether continuing treatment is the best option, or if treatment should be changed or stopped. The response to treatment may also be evaluated to help determine whether to continue treatment.

Quality measures

Structure

a) Evidence of local arrangements to ensure that adults taking zoledronic acid for 3 years have a review of the need for continuing treatment.

Data source: Local data collection, for example, local protocols.

b) Evidence of local arrangements to ensure that adults taking alendronate, ibandronate or risedronate for 5 years have a review of the need for continuing treatment.

Data source: Local data collection, for example, local protocols.

Process

a) Proportion of adults taking zoledronic acid for 3 years who have a review of the need for continuing treatment.

Numerator – the number in the denominator who have a review of the need for continuing treatment.

Denominator – the number of adults taking zoledronic acid for 3 years.

Data source: Local data collection, for example, local audit of patient records.

b) Proportion of adults taking alendronate, ibandronate or risedronate for 5 years who have a review of the need for continuing treatment.

Numerator – the number in the denominator who have a review of the need for continuing treatment.

Denominator – the number of adults taking alendronate, ibandronate or risedronate for 5 years.

Data source: Local data collection, for example, local audit of patient records.

Outcomes

a) Patient satisfaction with long-term bisphosphonate therapy.

Data source: Local data collection, for example, patient surveys.

b) Health-related quality of life for adults having long-term bisphosphonate therapy.

Data source: Local data collection, for example, patient surveys.

What the quality statement means for different audiences

Service providers (general practices, secondary care services and pharmacies) ensure that systems are in place for adults having long-term bisphosphonate therapy to have a review of the need for continuing treatment.

Healthcare professionals (GPs, specialists, specialist nurses and pharmacists) offer adults having long-term bisphosphonate therapy a medication review to discuss the risks and benefits of continuing treatment and assess their response to treatment, if needed.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission services in which adults having long-term bisphosphonate therapy have a review of the need for continuing treatment.

Adults taking a type of medicine called a bisphosphonate over a long time to help prevent fractures have a review to discuss the risks and benefits of continuing with the treatment. They might also have a scan to check whether their bone strength has improved to help decide whether to continue treatment.

Source guidance

Definitions of terms used in this quality statement

Long-term bisphosphonate therapy

Adults who have been taking zoledronic acid for 3 years or alendronate, ibandronate or risedronate for 5 years should have a review of the need for continuing treatment.

[National Osteoporosis Guideline Group's Clinical guideline for the prevention and treatment of osteoporosis, section 7, recommendation 6]

Review of the need for continuing treatment

Continuation of treatment is recommended for people with any of the following risk factors:

  • age over 75 years

  • previous hip or vertebral fracture

  • one or more low trauma fractures during treatment (after poor adherence to treatment, for example less than 80% of treatment has been taken, and causes of secondary osteoporosis have been excluded)

  • current treatment with oral glucocorticoids of 7.5 mg or more prednisolone/day or equivalent.

For people without risk factors, arrange a dual-energy X-ray absorptiometry (DXA) scan and consider:

  • Continuing treatment if the T-score is less than -2.5, and reassessing fracture risk and bone mineral density (BMD) every 3 to 5 years.

  • Stopping treatment if the T-score is greater than -2.5, and reassessing their fracture risk and BMD after 2 years.

[Adapted from NICE's clinical knowledge summary on osteoporosis – prevention of fragility fractures and National Osteoporosis Guideline Group's Clinical guideline for the prevention and treatment of osteoporosis, section 7, recommendation 4]