The first of the two new guidelines provides recommendations on the use of bisphosphonates, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women. For women who have been diagnosed with osteoporosis but have not yet had a fracture the bisphosphonate alendronate is recommended as a possible treatment, with risedronate and etidronate as alternatives if alendronate is contraindicated or not tolerated. If bisphosphonate treatment is unsuitable then strontium ranelate may be used as an alternative under certain circumstances. The guidance states that raloxifene is not recommended as a treatment for preventing fractures in postmenopausal women who have not had a fracture.
In the second of the new guidelines NICE states that alendronate (or etidronate or risedronate) is recommended as a possible treatment for the secondary prevention of bone fractures in postmenopausal women with osteoporosis. If bisphosphonates are unsuitable then strontium ranelate or raloxifene may be considered as possible alternatives under certain circumstances. Teriparatide may be considered as an option for women who cannot take bisphosphonates or strontium ranelate or for women who have had another fracture after taking a bisphosphonate for one year (and whose bone density has fallen).