PCRMM welcomes the publication of NICE NG259, updating and replacing CG146 (2012) with a clearer, more consistent risk assessment pathway. Several changes stand out as particularly valuable to primary care and community MSK practice:
- particularly the explicit recommendations for individualised assessment in trans and non-binary people, where sex registered at birth, hormonal history and current hormone treatment may all influence fracture risk.
- In addition, direct DEXA access (bypassing FRAX/QFracture) for people with a hip fracture, spinal fracture, or ≥2 fragility fractures;
- the 6-week DEXA fast-track for those likely to need anabolic therapy; which may pose a challenge to departments already struggling with waiting lists;
- and much more specific, criteria-based assessment for the 30–49 age group, replacing what was previously left to clinical judgement.
- We also note NICE’s own acknowledgement that the new unified 10% DEXA threshold — replacing the previous NOGG age-based approach — may reduce referrals in some areas even as the broader assessment criteria increase them elsewhere; local services should plan for this uncertainty in demand rather than assume a straightforward increase.
- We recognise this is Part 1 of a two-stage update, and look forward to Part 2’s promise of unified pharmacological treatment guidance, bringing the currently fragmented QS149/NOGG/TA464 threshold landscape under a single NICE framework.
