A judge has ruled that National Institute for Health and Clinical Excellence guidelines for treating osteoporosis on the National Health Service will remain in force while a re-evaluation of the recommendations takes place.

Last month a judicial review regarding NICE’s osteoporosis guidelines, which was instigated by Servier Laboratories, ruled that the Institute acted unlawfully by not unveiling the economic model that forms the basis of its recommendations for treatment on the NHS.

Consequently, NICE is being forced to disclose the model to stakeholders - including patient organisations, clinicians, professional organisations and industry – and will have to take into account any additional comments stakeholders may have in a re-evaluation of its guidance, thereby presenting campaigners with an opportunity to ensure more flexible access to osteoporosis therapies.

The decision was applauded by the company and patient groups alike, but the win has now been slightly soured by the judge’s ruling on Friday that current recommendations will remain in force until the re-assessment process is complete, effectively restricting patient access to certain drugs during this time.

“I am disappointed that Justice Holman has ruled that the NICE guidance on osteoporosis will not be quashed pending its re-evaluation,” commented Dr Tim Spector, Consultant Rheumatologist at St Thomas’ Hospital. But he also said he is “confident that healthcare professionals will exercise their professional judgement and ensure the best possible care for their patients”.

Speaking on behalf of the Institute, however, a spokesman said it is “very pleased that the guidance issued in October 2008 remains in force so that patients can access treatments currently recommended by NICE”.

Restricting access
Current guidelines state that patients unable to tolerate first line therapy with bisphosphonates have to wait for their bone mineral density to deteriorate before they are offered an alternative treatment such as Servier’s Protelos (strontium ranelate), which the company believes “unfairly and unnecessarily restricts access…for many patients who could benefit from it”.

Furthermore, according to Professor David Reid, Chair of the National Osteoporosis Society, £2.3 billion a year – or more than six million a day - is being shelled out on the treatment of hip fractures, but very little is spent on preventing those fractures from occurring in the first place, and he argues that this must change in order to ensure better outcomes for the disease.