The latest guidance from the National Institute for Health and Clinical Excellence regarding the treatment of osteoporosis in the UK has been welcomed by at least one drugmaker but has failed to appease one of the country’s leading patient groups.

NICE has issued a new Final Appraisal Determination Guidance for the primary and secondary prevention of osteoporosis which represents a considerable shift from a previous guidance which only recommended alendronate as a treatment option for postmenopausal osteoporosis patients. That decision was met with opposition from patient groups, notably the National Osteoporosis Society.

However the revised FAD now 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.

P&G has welcomed the news which creates a “clear stepwise process” but notes that there are “still some complexities within the guidance regarding thresholds for age and level of condition”. A finalised guidance will be issued later this year.

However the revised FAD has not gone down well with the NoS. The charity says that almost a year to the day that it launched an appeal against the proposed guidelines, NICE’s new set of guidance may include alternative treatments but still “makes it even harder than before for patients to fulfil the complex criteria which will enable them to access appropriate treatment”.

Nick Rijke, public and external affairs director for NoS, said that “this appraisal is extremely disappointing” because “we had hoped for real progress”. He added that NICE has now “published something that does not overcome the shortcomings of their previous work - if anything this makes things worse for many thousands of patients”.

Mr Rijke goes on to say that “the crux of the issue is that roughly a quarter of patients cannot take generic alendronate” and under the NICE recommendations, “those patients would have to get considerably worse before they would be entitled to an alternative treatment”. He concluded by saying that for those patients “it is hard to see why £7 a week is too much to ask” and given the “immense suffering and huge financial costs caused by hip fractures that effective treatment could prevent, the logical and moral imperative is to treat individuals with a drug that works.”

The NoS said that it will “consult fully with its stakeholders” before any decision is made regarding the next stage of the process.