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 |
|
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 | Copyright© 2016 - 2023 East Lancashire Medicines Management Board | All rights reserved. Disclaimer/Terms and conditions | |
|
|