The final guidance from the National Institute for Health and Clinical Excellence regarding the treatment of osteoporosis in the UK has been criticised by a charity which has dismissed it as unethical.

The final guidance recommends Procter & Gamble’s Actonel (risedronate) alongside the firm’s Didronel (etidronate), as the first alternative treatment option following generic alendronate. Strontium ranelate has been recommended as a second alternative therapy for women who cannot take bisphosphonate drugs.

Peter Littlejohns, NICE Clinical and Public Health Director and Executive Lead for the appraisal, said that the two new pieces of guidance “will provide postmenopausal women with consistent access to the most cost-effective treatments to either prevent a first osteoporotic fracture or to help stop an osteoporotic fracture from happening again”. He noted that this is the first time that national guidance has recommended drugs to help prevent a first fracture due to osteoporosis, “which is good news for those women at risk” and the guidance on secondary prevention recommends wider access to alendronate; it now covers “all postmenopausal women with confirmed osteoporosis, regardless of age”, Prof Littlejohn added.

Alternative effective treatments are also recommended for women who cannot take alendronate, he said, noting that NICE has considered the views of health professionals, those at risk of osteoporosis-related fractures and their families and carers during consultations. However, the guidance has been savaged by the National Osteoporosis Society.

Nick Rijke, public and external affairs director at the charity, said “we remain deeply dissatisfied with the guidance that NICE has produced which are unethical and short-sighted”. It is excessively rationing the cheapest generic drug, alendronate, and depriving patients who cannot tolerate the latter from access to alternative treatments to prevent fractures “until their osteoporosis has become significantly worse", he added.