Draft guidance issued by the UK’s drug cost-effectiveness body on the use of osteoporosis treatments has been greeted with dismay by the society representing patients with the bone disease.
The National Osteoporosis Society is concerned because the guidance, issued yesterday, reserves the use of the widely-prescribed bisphosphonate drugs, as well as Servier’s Protelos (strontium ranelate), for women aged over 75. At the moment there are no restrictions on prescribing these drugs under the National Health Service.
The National Institute of Health and Clinical Excellence (NICE) guidance covers use of the drugs in primary prevention – in other words in women with reduced bone mineral density who have not yet suffered a bone fracture.
Failing to offer treatment to prevent a first fracture in younger women “just does not make sense to us and we don’t believe it will make sense to women who will be denied a treatment," according to the NOS’ deputy chief executive Angela Jordan.
The draft guidance is open for a consultation period until October 20, and the Society has urged interested parties to make their voices heard on the issue.
Meanwhile, guidance on access to osteoporosis medicines for women who have already suffered a fracture – secondary prevention – has also been updated by the NICE, and does not impose an age restriction on the start of treatment.
This proposes a set process for selecting treatment options, with Merck Sharp and Dohme’s Fosamax (alendronate) and Procter & Gamble’s Didronel (etidronate) the first-line options, with P&G’s Actonel (risedronate) an alternative if the patient has very low bone density and cannot take alendronate. Next in line is strontium ranelate - recommended if the woman cannot take any of the bisphosphonate drugs – followed by Eli Lilly’s oestrogen modulator Evista (raloxifene).
Eli Lilly’s Forteo (teriparatide) is included in the guidance for the first time, reserved for use in women with very low bone mineral density who have previously had three or more fractures.
But the NOS is also unhappy about the updated guidance on secondary prevention.
“NOS is concerned that it will prove extremely complicated for doctors to follow the very specific way that doctors can prescribe drugs to women,” said Jordan.