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Novel therapy in osteoporosis

Portfolio politics

Louise Newson

Tuesday, 12 October 2010

osteo.jpgThe number, rate and cost of fractures in the UK amongst women aged over 55 is rising. The total number of women prescribed medication for osteoporosis in the UK is approximately 480,000 and this is increasing with our ageing population.

Osteoporosis is not a benign disease – one study found that 9% of women who were admitted to hospital with a fracture died without returning home.

Several of my patients with osteoporosis have come in recently to ask whether they could have one of the alternative treatments that they have read about in their daily newspaper called denosumab. I did not know much about this drug so decided to look into it further.

Denosumab is a human monoclonal antibody to RANKL (Receptor activator of nuclear factor kappa B ligand). It is a different and novel approach to prevent fragility fractures in osteoporosis. Receptor activator of nuclear factor kappa B ligand is responsible for osteoclast differentiation, activity, and survival. Studies have shown that denosumab exerts rapid, marked, and sustained effects on bone resorption, resulting in falls in the markers of bone turnover. Studies have demonstrated that it increases bone mineral density at one year to a greater extent than weekly alendronate.

NICE recently issued its Final Appraisal Determination for Denosumab (Prolia) for the prevention of osteoporotic fractures in postmenopausal women. This is the last stage before the NHS gets the go ahead to use a treatment as specified by NICE. This is very encouraging and is thought to be a practical alternative to bisphosphonates, which actually can not be tolerated by up to a quarter of people who have been prescribed them.

Another advantage of denosumab is that it requires only two subcutaneous injections each year which is obviously far more convenient than taking weekly bisphosphonates.

Obviously the success of this treatment will depend on the long-term effectiveness and safety profile of this drug. I do not know about the cost effectiveness of this drug but studies have (unsurprisingly) already shown that compliance to treatment is far better that with bisphosphonates. It will be interesting to see if and when it will receive final approval from NICE.

Author's Image

Louise Newson

Louise is a part-time GP in Solihull, as well as a writer for numerous medical publications, including www.patient.info. She is an Editor and Reviewer for e-learning courses for the RCGP. She is an Editor for Geriatric Medicine journal and the British Journal of Family Medicine. Louise has contributed to various healthcare articles in many different newspapers and magazines and is the spokesperson for The Information Standard. She has also done television and radio work. Louise is a medical consultant for Maverick TV and has participated regularly in ‘Embarrassing Bodies Live from the Clinic’. Louise has three young children and is married to a consultant urological surgeon. Although her spare time is limited she enjoys practising ashtanga yoga regularly and loves road cycling – she has raised over £2K for a local charity, Molly Olly Wishes by competing in a 120km cycle ride!
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