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PRIMARY prevention of osteoporotic fragility fractures in postmenopausal women

PRIMARY prevention of osteoporotic fragility fractures in postmenopausal women

6.6.2 Bisphosphonates and other drugs affecting bone metabolism

Raloxifene for the PRIMARY prevention of osteoporotic fragility fractures in postmenopausal women (NICE TA160)
- updated February 2018. (The title and guidance of TA160 have been updated to reflect the current recommendations.) 

Nice has issued up-to-date guidance  on bisphosphonates for treating osteoporosis.
 
NICE  withdrew its guidance on the issue of etidronate and strontium ranelate for the primary prevention of osteoporotic fragility fractures 
 ipostmenopausal women because etidronate and strontium ranelate are no longer marketed in the UK.
 
For an overview of the Management of osteoporosis <click here>
 
Alendronate
Alendronate is recommended as a treatment option for the primary prevention of osteoporotic fragility fractures in 
post menopausal women.
 
When the decision has been made to initiate treatment with alendronate, the preparation prescribed should be chosen on the 
basis of the lowest acquisition cost available.
 
Alendronate - First Line Bisphosphonate
GREEN      Alendronate tablets 70mg once weekly + prescribe Evacal® D3 (cost effective option) or Adcal D3 1 tab twice daily
 
Apart from alendronate, no other bisphosphonate (or any other treatment) should be initiated first line for primary or
secondary prevention of osteoporosis.
 
An effervescent formulation of alendronic acid , for specific patients with swallowing difficulties is available as an alternative to
improve compliance. Consultant initiation only.   
 
AMBER     Alendronic acid effervescent tablets 70mg (Binosto®)
 
Risedronate - Second Line Bisphosphonate   
Risedronate is recommended as alternative treatment option for the PRIMARY prevention of osteoporotic fragility fractures 
in postmenopausal women:
                  >   who are unable to comply with the special instructions for the administration of alendronate, or have a 
                       contraindication to or are intolerant of alendronate, and
                  >   who also have a combination  of T-score, age and number of independent clinical risk factors for fracture as in the
                       attached  table.
 
GREEN      Risedronate   
                   tablets 35mg once weekly + prescibe Evacal D3 (cost effective option) or Adcal D3 1 tab twice daily 
                   tablets 5mg daily + prescribe Evacal D3 (cost effective option) or Adcal D3 1 tab twice daily 
 
Denosumab 
Position Statement  - Denosumab as a second line treatment option for the prevention of osteoporotic fragility fractures
                                    in men and women from  the age of 50 years.
                                      
Denosumab is recommended as a second line treatment option for the primary prevention of osteoporotic fragility fractures
in postmenopausal women and men from the age of 50 years at increased risk of fracture  who are unable to comply with
the special instructions for administering alendronate and risedronate, or have an intolerance of, or a contraindication to 
those treatments and the patient has a combination of T-score, age and number of independent clinical risk factors for fracture as 
indicated in NICE TA204
 
AMBER SHARED CARE    Denosumab injection, pre-filled syringe 60mg (Prolia®)
                                            click here for Shared Care Agreement 
  
 
Denosumab for the prevention of skeletal-related events in adults with bone metastases from solid tumours NICE TA265

Treatment of Osteonecrosis of the Jaw  - click here
 
 
 
 
 
 
 
 

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 public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service 
  Email: info.elmmb@nhs.net
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