As is often the case with a slowly moving review process, newer therapies have selleck screening library emerged even as other therapies remain under evaluation, so that guidance is now restricted to a subset of agents currently licensed for the treatment of postmenopausal osteoporosis. Before NICE, the guidelines of the Royal College of Physicians were widely utilised in the UK [3, 4]. These suggested that the decision to initiate therapy be based largely on physician assessment of a range of clinical risk factors for fracture, followed
by a DXA scan, using the WHO threshold (a T score of −2.5) as the marker for intervention. Over the previous two decades, clinicians have been inundated with studies suggesting that several risk factors might comprise indications for bone densitometry, and it was clear that some of these acted on fracture risk through an influence on bone mineral density (BMD), while others did not. In addition, some risk factors were amenable to modification (for example, intake of alcohol and smoking), whereas others, such as age and gender, were not. Finally, it was felt that meaningful dialogue between patient and physician was inhibited by difficulties in explaining the likelihood of fracture using the T score,
and that this also impacted adversely on adherence rates to osteoporosis medication (below 50% at 1 year). Thus, the traditional approach had become relatively ineffective and not sufficiently prescriptive about how to use the many available therapies. In the intervening period check details between the Royal College of Physicians guidance and the appraisals provided by the NICE, the WHO supported development of a fracture
risk assessment tool, which was completed in 2008 (FRAX®). The FRAX algorithm (http://www.shef.ac.uk/FRAX) uses a variety of clinical risk factors, easily assessed in clinical practice, with or without the addition of a BMD result, to compute the 10-year probability of fracture for an individual. From this, a clinician and patient can decide on the initiation of therapy. Rolziracetam With the difficulties inherent in the NICE appraisals, and the emergence of the FRAX algorithm, a novel approach to osteoporosis care was proposed by the National Osteoporosis find more Guideline Group (NOGG) . This incorporates the use of the FRAX algorithm, together with intervention thresholds validated but not driven by cost-utility analyses, to target therapy to patients. In a recent issue of the Archives of Osteoporosis, Kanis and colleagues provide a detailed critique of the NICE guidance for the prevention of fragility fractures in postmenopausal women with osteoporosis, which highlights the practical difficulties it raises and concerns regarding the modelling employed .