Low cost osteoporosis drugs are strictly rationed for the under 75s, and UK physicians hampered by restrictive guidelines, according to findings which appear today in the journal Therapeutic Advances in Musculoskeletal Disease, published by SAGE. A leading Cambridge University bone health expert has outlined flaws in NICE osteoporosis treatment guidance, which limits options for many postmenopausal women in the under-75 age bracket.
According to Cambridge University Professor of Bone Medicine, Juliet Compston, the current UK guidelines are unnecessarily complex. Physicians following the guidelines treat postmenopausal women aged over 75 with low trauma fractures (known as fragility fractures) with alendronate. This drug prevents further bone weakening by preventing the loss of bone that occurs with ageing.
However, physicians treating postmenopausal women under 75 with similar fractures have to demonstrate that the patient has bones scoring -2.5 or less on the 'T-score,' a measure of bone mass, to prescribe alendronate. There are alternatives for those who cannot take alendronate (etidronate, risedronate, or strontium ranelate or, for secondary prevention only, raloxifene) but a prescription for one of these often requires even more stringent criteria.
Alendronate, the first line of treatment, is available as a 'generic' drug and costs less than -20 per year to prescribe. With the second raft of treatments costing -350 per year or less, physicians are faced with a difficult ethical dilemma in patients who are intolerant to alendronate as they know that these treatments are effective, yet they often cannot prescribe them until the patient has lost more bone. This is particularly unfortunate since intolerance to alendronate is common in frail elderly women, who are at very high risk of suffering further fractures.
There are no current NICE guidelines for treating men with fractures, or either men or women treated with glucocorticoids, which are a common cause of osteoporosis. Without NICE guidelines, cash-strapped primary care organisations may chose not to extend treatment to these individuals.
Osteoporosis leads to over 1000 deaths each month in the UK alone from hip fractures, and costs the National Health Service (NHS) and UK government -2.3 billion each year, according to figures from the National Osteoporosis Society charity. Factors such as drinking three or more units of alcohol per day, a family history of osteoporosis and long-term rheumatoid arthritis are among those that can increase fracture risk.