Oral bisphosphonates are recommended if the 10‑year probability of osteoporotic fragility fracture is ≥1%. Intravenous bisphosphonates are recommended only if the 10‑year probability of osteoporotic fragility fracture is at ≥10% or between 1% and 10% if the person has difficulty taking oral bisphosphonates or if oral bisphosphonates are contraindicated or not tolerated.
This guidance updates NICE TA160 (Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women) and NICE TA161 (Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women). Recommendations for raloxifene, strontium ranelate and teriparatide in these technology appraisals remain. The manufacturers and distributors of strontium ralenate have indicated that they will cease production of this product by the end of August 2017.