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There are two publishes technology appraisals in osteoporosis:

TA 160: the Primary Prevention Guideline

TA 161: the Secondary Prevention Guideline


NICE have also issued clinical guidance on Falls Management

CG 21

These can be accessed in full from www.nice.org.uk


In the primary prevention guideline the woman will not have suffered a fracture to date but will be considered at risk based on clinical risk factors and DXA scanning results.

If the woman is over 65 years of age and has a t-score <-2.5 SD and an independent clinical risk factor for fracture then alendronate is recommended. If under 65 years then a higher threshold exists prior to initiating treatment with alendronate.

The use of other agents, including other bisphosphonates has a higher threshold of intervention-this is due to the difference in price of generic alendronate compared to all other preparations.

The secondary prevention guideline (for those women who have already experienced a fracture) alendronate is the medication of choice to prevent further fractures. Intervention with other agents is only possible at higher fracture risks and tables exist on the NICE website to determine at what threshold intervention is felt appropriate with other agents when the patient is unable to tolerate oral Alendronic acid. This guidance has been subject to appeals and high court judgements, final revised advice is awaited but current guidance currently stands.