Within the NHS, oral bisphosphonates (alendronic acid, ibandronic acid and risedronate sodium) are now recommended as options for treating osteoporosis in adults if:
- the person is eligible for risk assessment as defined in NICE's guideline on osteoporosis and
- the 10-year probability of osteoporotic fragility fracture is ≥1%.
Intravenous bisphosphonates (ibandronic acid and zoledronic acid) are recommended as treatment options in adults if:
- the person is eligible for risk assessment as defined above and
- the 10-year probability of osteoporotic fragility fracture is ≥10% or
- the 10-year probability of osteoporotic fragility fracture is ≥1% and the person has difficulty taking oral bisphosphonates or these are contraindicated or not tolerated.
The 10-year probability of osteoporotic fragility fracture should be estimated using the FRAX or QFracture risk tools, in line with the NICE osteoporosis guidance.
Treatment choice should be made on an individual basis, where possible starting treatment with the least expensive formulation. Patients already being treated with bisphosphonates outside the new recommendations may continue according to the current funding arrangements until they and their clinician consider it appropriate to stop.
The NICE guidance on the primary and secondary prevention of osteoporotic fragility fractures in postmenopausal women (TA160 and TA161) remains valid except for the sections related to the use of bisphosphonates, which have been superseded by the new guidance.