NICE has published new guidance on the use of drugs called bisphosphonates for preventing bone fractures in people at increased risk.

The new guidance links a person’s risk of having a bone fracture with the point at which treatment should be started, based on cost effectiveness.

It recommends treatment with oral bisphosphonate drugs alendronic acid, ibandronic acid and risedronate sodium as options for people who have at least a 1% risk of a bone fracture within the next 10 years.

The new guidance also recommends the injected bisphosphonates ibandronic acid and zoledronic acid for people who have at least a 10% risk of a bone fracture within the next 10 years.

The guidance says that the 10-year probability of having a bone fracture should be estimated using the FRAX or QFracture risk tools, in line with NICE’s existing guideline on osteoporosis.

For some people with a 1% risk of a bone fracture oral bisphosphonates may be contraindicated or not tolerated, or taking them might be difficult or impossible. For these people injectable bisphosphonates are recommended.

Osteoporosis is where a person’s bones - most commonly in the spine, hip and wrist - deteriorate making them more fragile and susceptible to fracture. This can lead to the bone fracturing as a result of a force that wouldn’t normally cause a break in a healthy bone, such as a fall from a standing height or less.

Risk factors for bone fractures because of osteoporosis include: increasing age; a history of falls; a previous bone fracture because of osteoporosis; smoking; current use or frequent recent use of steroids; and an alcohol intake of more than 14 units per week for women and more than 21 units per week for men. Women are at greater risk because after they have gone through the menopause their bone loss accelerates.

Each year in the UK more than 300,000 people are seen in hospital because of fractures as a result of osteoporosis.

Professor Carole Longson MBE, director of the centre for health technology evaluation at NICE, said: “Bone fractures because of osteoporosis can cause substantial pain and severe disability, so we‘re pleased to be publishing this new guidance. It will provide clarity for health professionals about when to start treatment with bisphosphonates and it will provide people who have osteoporosis with access to the most cost-effective treatments to prevent then getting a fracture.”