Evidence-based recommendations on the bisphosphonates alendronic acid, ibandronic acid, risedronate sodium and zoledronic acid for treating osteoporosis.

The purpose of this technology appraisal was to establish at what level of absolute fracture risk bisphosphonates are cost effective. Please note that because of the reduction in prices for oral bisphosphonates over the last few years, the absolute risk level at which these drugs are cost effective is now very low. The absolute risk level at which oral bisphosphonates are recommended as treatment options in this guidance are therefore not clinical intervention thresholds. This technology appraisal guidance should be applied clinically in conjunction with:

  • NICE guideline on assessing the risk of fragility fractures (CG146) that defines who is eligible for osteoporotic fracture risk assessment.
  • NICE quality standard on osteoporosis (QS149) that defines the clinical intervention thresholds for the 10-year fracture probability of a major osteoporotic fracture, in those patients who have undergone fracture risk assessment. These thresholds are based on the NICE-accredited National Osteoporosis Guideline Group guideline.
  • The individual person’s circumstances, goals and informed preferences.

Further information is in the implementation section.

Is this guidance up to date?

We reviewed the evidence in July 2019 and updated the recommendations and section 4.

Next review: 2022

Guidance development process

How we develop NICE technology appraisal guidance

This guidance partially updates NICE technology appraisal guidance on raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women (TA160) and on raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (TA161).

Your responsibility

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.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

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.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)