1. Denosumab NICE technology appraisal guidance 204 October 2010

2. What is it? Human monoclonal antibody that inhibits osteoclast formation and function, so reduces bone resorption A treatment for the prevention of osteoporotic fractures in postmenopausal women Injection every 6 months (£183 = £1/day)

3. When to use it? Primary prevention: only if combination of age, T-score and risk factors make it appropriate AND Unable to tolerate alendronate, risedronate etc, or have contraindication Independent risk factors: Parental history of hip fracture 4 or more units alcohol per day Rheumatoid disease Age (years) Number of independent clinical risk factors for fracture 012 65-69 - *-4.5-4.0 70-74 -4.5-4.0-3.5 >75 -4.0 -3.0 *Treatment with denosumab is not recommended T-scores (SD) at (or below) which denosumab is recommended

4. When to use it (2) Secondary prevention of osteoporotic fragility fractures: Postmenopausal women, at increased risk of fractures, and unable to tolerate alendronate, risedronate etc, (or have contraindication)