Abaloparatide is recommended as an option for treating osteoporosis after menopause in women, trans men and non-binary people, only if they have a very high risk of fracture (see section 3.2). It is only recommended if the company provides it according to the commercial arrangement.
If people with the condition and their healthcare professional consider abaloparatide, romosozumab and teriparatide to be suitable treatments, after discussing the advantages and disadvantages of all the options, the least expensive suitable treatment should be used. Administration costs, dosages, price per dose and commercial arrangements should all be taken into account.
This recommendation is not intended to affect treatment with abaloparatide that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.
Why the committee made these recommendations
Usual treatments for osteoporosis after menopause include romosozumab or teriparatide and bisphosphonates such as alendronic acid. For this evaluation, the company asked for abaloparatide to be considered only for people who have a very high risk of fracture. This does not include everyone who abaloparatide is licensed for. It would be used as an alternative treatment to romosozumab or teriparatide.
Clinical trial evidence shows that abaloparatide followed by alendronic acid is more effective at reducing the risk of some types of fracture than placebo followed by alendronic acid. Indirect comparisons suggest that abaloparatide is likely to work at least as well as romosozumab and teriparatide.
The most likely cost-effectiveness estimates for abaloparatide are within the range that NICE considers an acceptable use of NHS resources. So, abaloparatide is recommended.