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New guidance and generic medication linked to decrease in subsequent fracture rate

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The fracture rate among osteoporosis patients in the UK declined after new prescribing guidance was published and a low-cost bisphosphonate treatment became available, a study has shown.

The analysis, funded by the National Institute for Health Research (NIHR) and published in the Journal of Bone and Mineral Research, looked at the prescribing rate for anti-osteoporosis medication and the incidence of subsequent fracture among primary hip fracture patients in England and Wales.

In 2005, the National Institute for Health and Care Excellence (NICE) in England and Wales provided new guidance recommending the use of bisphosphonate for the prevention of additional fractures in patients who had experienced osteoporotic fractures. This was followed by UK market authorisation of generic bisphosphonate alendronic acid.

After analysing the records of 10,873 primary hip fracture patients, the researchers found that publication of the NICE guidance and the availability of generic alendronic acid led to an almost 15% increase in prescribing of anti-osteoporosis medication and a 14% decline in subsequent fractures in the hip, pelvis, proximal-humerus, rib, spine, or wrist/forearm over a period of three years. Considering only hip fractures, there was a 22% reduction in fractures.

“It is clear that the guidance coupled with the availability of a low-cost bisphosphonate treatment drove a major change in prescribing by general practitioners,” commented study co-senior author Associate Professor Andrew Judge of the NIHR Musculoskeletal Biomedical Research Unit at the University of Oxford. “It is unclear how much this was due to the new guidance and how much due to generic alendronic acid arriving on the market, but it is notable that prescriptions for alendronic acid clearly outstrip those for other treatments, suggesting that it had a part to play.”