TY - JOUR T1 - A fractured service: will NOGG mend it? JF - British Journal of General Practice JO - Br J Gen Pract SP - 371 LP - 372 DO - 10.3399/bjgp09X420680 VL - 59 IS - 562 AU - Jonathan Bayly Y1 - 2009/05/01 UR - http://bjgp.org/content/59/562/371.abstract N2 - Alun Cooper rightly points out the burdens of fragility fractures and the difficulties that arise if we focus on the risk factor (osteoporosis) and not the end organ damage (the fracture).1 The slow evolution of meaningful guidance from the National Institute for Health and Clinical Excellence (NICE) has attracted criticism as has its restrictive health economic model.The suggestion that a solution presents itself in the new FRAX® algorithm3 allied to new rival guidance from the National Osteoporosis Guidelines Group (NOGG) should be critically appraised.Generic alendronate is now £20/year or about one-tenth of its cost when NICE first formulated their relevant technology appraisal, and cost-effectiveness arguments may now make it affordable for many more patients even if NICE may alter the model constantly. The suggestion by the NOGG authors however, that treatment should be considered in 24% of 50-year-old women and 47% of 80 year olds1 may raise alarm bells for a number of reasons. How long should … ER -