Page last updated at 10:16 GMT, Tuesday, 8 September 2009 11:16 UK

Row over access to bone therapies

By Sudeep Chand
BBC News

Osteoporotic bone
Osteoporosis is a very common condition

Thousands of women in England and Wales could suffer broken bones each year because of a lack of treatment, according to a leading physician.

Professor David Reid, from University of Aberdeen, said postmenopausal women may find they they are denied access to effective osteoporosis drugs.

He said current National Institute for Health and Clinical Excellence (NICE) guidance is too restrictive.

NICE said its guidance should enable women to get high quality care.

But Professor Reid called for a review of the current guidance should be speeded up.

Normal ageing can lead to osteoporosis, a condition in which bones become fragile and break easily. The fractures are most common in bones of the spine, wrists and hips.

Women who have gone through the menopause are at increased risk of osteoporosis because their ovaries no longer produce oestrogen, which protects against bone loss.

Whether or not someone is offered treatment will depend on their age, bone density and how many risk factors they have.

New treatments

NICE currently recommends the drug Alendronate as a possible treatment to prevent further damage in postmenopausal women who have already had a fracture due to osteoporosis.

Sometimes women cannot take the drug, often because it causes heartburn or they have trouble swallowing.

It can also be tricky to take, since you have to remain upright for 30 minutes after taking the drug.

However, although NICE does recommend alternatives be tried in these circumstances, critics say it has placed too many caveats on their use.

Professor Reid is chair of the National Osteosporosis Society and is on the speaker's bureau for Novartis, one of the manufacturers of the new, more expensive drugs.

He told BBC News: "The issue is those who can't take the drug.

"Then NICE allow other drugs to be used, but you have to be a little worse before you can use them.

"That's not how we work. You can't come to your doctor and say have you got something else for me, and be told come back in two years time."

Professor Reid said the NICE guidance was driven by cost, but he said the alternative treatments were not hugely expensive.

For instance, he said one of the drugs zoledronic acid - a once a year injection already widely available in Scotland - costs £250, compared with £50 for Alendronate.

When asked why access to these treatments was important he said: "About one in five who have a fracture of the spine will have another fracture within year.

"So one in five will have another fracture that they didn't need to have. That's not in my view good practice."


This is not the first time that NICE has been criticised on this particular piece of guidance which was issued in October 2008.

A judicial review was carried out earlier this year.

In February 2009, the High Court ruled in favour of NICE on two grounds of discrimination against disabled people and handling clinical trial data.

However, the judge said that NICE could have done more to release information about the costing models it used.

A NICE spokesperson said its guidance should mean that postmenopausal women were given consistent access to the most cost-effective treatments.

New clinical guideline on osteoporosis was planned, but was currently on hold due to legal issues.

In the meantime the priority was to stop women from suffering any osteoporotic fractures in the first place.

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