Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women.

This guidance replaces TA87 Osteoporosis - secondary prevention.

Whether or not a postmenopausal woman who has had a bone fracture because of osteoporosis is offered treatment to prevent further fractures will depend on her age, her bone density and how many risk factors for fracture she has.

Alendronate is recommended as a possible treatment for preventing bone fractures in postmenopausal women who have already had a fracture and have had osteoporosis diagnosed.

If a woman can't take alendronate, risedronate and etidronate are recommended under certain circumstances as possible alternative treatments to prevent further fractures.

If a woman can't take alendronate or either risedronate or etidronate, then strontium ranelate and raloxifene are recommended under certain circumstances as possible alternative treatments to prevent further fractures.

If a woman can't take alendronate, or either risedronate or etidronate, or strontium ranelate, teriparatide is recommended under certain circumstances as a possible alternative treatment to prevent further fractures. Teriparatide is also recommended as a possible alternative treatment for a woman who has another fracture when she has been taking alendronate, risedronate or etidronate for 1 year (and her bone density has fallen).

The guidance says that women who are 75 or over may not need a bone scan to diagnose their osteoporosis.

• Update 26 January 2011

  NICE has published updated final guidance on preventing osteoporotic fractures following a reconsideration of the use of strontium ranelate for the prevention and treatment of osteoporotic fragility fractures in postmenopausal women.

  In accordance with the Court of Appeal’s ruling on the technology appraisals of drugs for the prevention and treatment of osteoporotic fragility fractures in postmenopausal women, NICE asked the manufacturer of strontium ranelate to submit additional evidence. After having examined this additional evidence on strontium ranelate and an independent expert review of the evidence very carefully, the new independent Appraisal Committee reached the same conclusions as the original Appraisal Committee, and so the recommendations on strontium ranelate remain unchanged from those published originally. Consultees then had a chance to appeal against this decision but no appeals were received.

  NICE guidance on the use of alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the prevention and treatment of osteoporotic fragility fractures in postmenopausal women therefore remains unchanged.

• Other information

  • TA161 Osteoporosis - secondary prevention including strontium ranelate: guidance (web format)

  How this guidance was produced

  Background information

  • TA161 Osteoporosis - secondary prevention including strontium ranelate: review update - July 2010
  • Osteoporosis - secondary prevention including strontium ranelate: final appeal panel decision

Guidance formats

• Web format
• Quick reference guide (PDF)
• Full Guidance (PDF)
• Patient version (MS Word)
• TA161 Alendronad, etidronad, risedronad, strontiwm ranelad a teriparatid ar gyfer atal toriadau mewn merched ar ôl diwedd y misglwyf sydd ag osteoporosis sydd eisoes wedi cael toriad: deall canllawiau NICE (fformat MS Word)

Osteoporosis - secondary prevention including strontium ranelate

Guideline for patients and carers (PDF)