PRIMARY prevention of osteoporotic fragility fractures in postmenopausal women

PRIMARY prevention of osteoporotic fragility fracture 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 in postmenopausal 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

Ibandronic Acid (Bondronat®)

Adjuvant treatment of early breast cancer in postmenopausal women with a high risk of recurrence

AMBER Ibandronic acid (Bondronat®) (unlicensed indication)

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

MHRA Drug Safety Update August 2020: Denosumab 60mg [Prolia]: risk of multiple vertebral fractures after stopping or delaying

ongoing treatment

ll material in this section is aimed at health care professionals, but is information currently held in the public domain, members of the

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