MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Calcium regulating drugs

National Guidance

National Osteoporosis Guideline Group (NOGG) Clinical guideline for the prevention and treatment of osteoporosis, updated September 2021

 TA161 Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in post menopausal women, updated February 2018

Calcitonin is a hormone produced by the thyroid gland and is involved in helping to regulate levels of calcium and phosphate in the blood, opposing the action of parathyroid hormone and slows bone turnover. Calcitonin is licensed for prevention of bone loss due to sudden immobility, hypercalcaemia of malignancy and for the treatment of Paget's disease. It is not recommended for osteoporosis treatment because benefit is outweighed by the risk of malignancy associated with long-term use.

Strontium ranelate is licensed for the treatment of severe osteoporosis in postmenopausal women and adult men at high risk of fracture who cannot use other osteoporosis treatments. The decision to prescribe should be based on an assessment of the individual patient's overall risks. Strontium is contraindicated if there is a history of ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, uncontrolled hypertension, current or previous VTE, temporary or permanent immobilisation or hypersensitivity to the active substance or any excipients. Treatment should be re-evaluated every 6-12 months and strontium discontinued if any of the above conditions develop. For more detailed information, see the SPC (via emc) and risk minimization information. A strontium ranelate patient alert card should be given to each patient.

Teriparatide is a recombinant protein form of parathyroid hormone. It is licensed for the treatment of osteoporosis in post menopausal women and in men at increased risk of fractures. Use can only be initiated by a specialist consultant according to NICE guidance.