Better, but more expensive, treatment will not be assessed by Nice for three years
Osteoclasts on a vertebral bone in an osteoporosis sufferer. Photograph: Alan Boyde/Wellcome Trust Medical Photographic Library
Thousands of British women are being denied modern drugs to treat a common bone-thinning disease because guidelines surrounding its use are too stringent, doctors warn.
The majority of patients who are diagnosed with osteoporosis, which causes the bones to become dangerously brittle in old age, are prescribed a weekly pill, even though a more effective once-a-year injection is available.
A significant number of patients refuse to take the weekly alendronate pill because of its uncomfortable side-effects, but are not offered the alternative of a drug infusion called zoledronate, because they are not ill enough to qualify for it, doctors said.
"It's bad medical practice. You can't tell a patient they can't have this treatment because they are not ill enough," said David Reid, professor of rheumatology at Aberdeen University.
Half of women and a fifth of men over 50 suffer bone fractures due to osteoporosis, and only a 20% of all patients who fracture a hip in a fall survive for more than a year. In Britain alone, 480,000 women are prescribed drugs to treat osteoporosis.
Alendronate is an older drug and costs £50 a year to treat each patient, but unless it is taken in line with a strict dietary regime, it can cause indigestion and other side-effects. Zoledronate costs around £250 a year, but doctors argue it could help thousands of patients who give up taking alendronate.
The National Institute for Health and Clinical Excellence (Nice), which advises the NHS on drug use is not scheduled to assess zoledronate for another three years, the doctors told the British Science Association festival in Guildford.
"There is a clear benefit to many patients in the ease of taking a once-a-year treatment, rather than having to take pills every day or every week, with a complex fasting regime," Rob Dawson at the National Osteoporosis Society said.
"We accept the need for Nice to put zoledronic acid through a proper appraisal, but we want this to be done through a much more enlightened process than other osteoporosis treatments have been through. Otherwise Nice stand in the way of medical progress," he added.
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