Finding new ways to treat osteoporosis
Osteoporosis is a condition where the bones become weak, are described as fragile and can easily break (fracture). When a person has suffered one fracture from a fall of standing height or less (a fragility fracture), the risk of sustaining another fragility fracture is high.
Bisphosphonates are a group of medicines prescribed for people with, or at risk of osteoporosis, that reduce the risk of these fragility fractures. Most commonly a bisphosphonate called Alendronate is used, however, dosing instructions are complex and only 1 in 4 people continue with the Alendronate for more than two years after starting to take it. There are many reasons for this, which include uncertainty about the benefits and safety, lack of understanding of the consequences of non- treatment and risks of, or actual side effects.
Alternative bisophosphonates are available, however, we do not know which regimens are most effective at reducing fractures, provide the best value for money and are most acceptable to patients.
The study will look at how effective different bisphosphonate regimens are compared to Alendronate at preventing fractures, whether the reduction in fracture risk can be achieved at a reasonable financial cost and to establish the acceptability of different approaches to patients.
How this study will help patients
This study will benefit patients, clinicians and the NHS by identifying:
- which bisphosphonate treatments are most effective at reducing fractures, provide the best value for money and are most acceptable to patients
- what patients, clinicians and researchers think are the most important research questions to inform future research in this area.
The study will be carried out in different stages:
- Stage 1A will review of published literature on the effectiveness of and value for money provided by bisphosphonates for the prevention of fragility fractures published in 2016. The original work informed current national guidelines. We will include additional studies and data which look at treatment compliance, long-term persistence and medication safety/side-effects.
- Stage 1B will look at existing evidence reporting patients and doctors’ views, experiences and preferences regarding different bisphosphonate regimens. This will be followed by face-to-face interviews to explore the findings from the review. Interviews will be conducted with patients, doctors and other healthcare workers/managers (including researchers) in centres that provide services for patients with osteoporosis. We will make sure the centres chosen represent a range of services and different approaches.
- Stage 2 will use the findings from Stage 1A and 1B to identify areas of uncertainty and we will work with a nationally representative sample of patients, clinicians and researchers to generate research questions from these uncertainties. We will then hold a face-to-face national representative, multidisciplinary stakeholder event to rank these questions in order of priority for future research
Working with patients
We have worked closely with the National Osteoporosis Society (NOS) and the Nottingham NOS (NotNOS) Support Group, who together have influenced the design of this application, choice of study outcomes, and who will be involved throughout the study. The NOS and two members from NotNOS have agreed to be co-applicants.