The video version of this podcast can be found here: · https://youtu.be/SA7pJQLlmvgThis episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I go through new and updated recommendations published in August 2024 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only. I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The Full NICE News bulletin for August 2024 can be found here:· https://www.nice.org.uk/guidance/published?from=2024-08-01&to=2024-08-31&ndt=Guidance&ndt=Quality+standard The links to the current guidance can be found here:Diabetic retinopathy: Management and monitoring:· https://www.nice.org.uk/guidance/ng242Abaloparatide for treating osteoporosis after menopause:· https://www.nice.org.uk/guidance/ta991National Osteoporosis Guideline Group (NOGG) clinical guideline for the prevention and treatment of osteoporosis:· https://www.nogg.org.uk/full-guidelineIntro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I am Fernando, a GP in the UK. Today, we are looking at the NICE updates published in August 2024, focusing on what is relevant to Primary Care only. We are going to cover just two areas, the treatment of osteoporosis and the management of diabetic retinopathy, so it is a brief episode. Let’s jump into it. The first area is a technology appraisal on Abaloparatide for treating osteoporosis after the menopause.And you may be thinking, Abaloparatide, is this really something that we need to know about in Primary Care?And the answer is yes. And let’s see why.And we will start by saying that treatments of osteoporosis can be broadly divided into 2 types:· antiresorptive treatments (which slow the rate of bone breakdown), such as our usual bisphosphonates and· anabolic (or bone-forming) treatments.Treatment with anabolic skeletal agents result in rapid and greater fracture risk reductions than bisphosphonates. So, if we are used to prescribing bisphosphonates for the majority of our patients, who should be getting anabolic agents instead? And the guidelines stipulate that people with a very high fracture risk should be referred for the consideration of these agents. According to the National Osteoporosis Guideline Group, 'very high risk' is defined as a FRAX-based fracture probability that exceeds the intervention threshold by 60%. So, looking at this diagram based on FRAX, we can see how patients can fall into the different risk categories depending on their scores. Apart from the patients already in the very high risk of fractures, we should also consider additional clinical risk factors for patients in the high-risk category, (e.g., frequent falls, or a very low spine Bone Mass Density) in case that they may move them from high to very high risk of fracture. So, in summary, we need to be aware that these anabolic drugs exist and that they are recommended for people with a very high risk of fractures so that when we see such patients, we refer them appropriately to get these drugs.Existing anabolic treatments are Romosozumab and Teriparatide and, following this technology appraisal, NICE recommends Abaloparatide too. These anabolic agents can only be taken for a limited time between 12 and 24 months depending on the drug, and afterwards patients will continue to receive an antiresorptive treatment (such as an oral bisphosphonate). Although abaloparatide is licensed for 'treatment of osteoporosis in postmenopausal women', we must also include ...
