104 CHAPTER 2.2 Table SI1.5 Continued. START Action Clarity rating Condition Clarity rating Explanation Clarity rating D D1 Proton Pump Inhibitor 67% with severe gastro-oesophageal reflux disease or peptic stricture requiring dilatation. 50% N/A D2 Fibre supplements (e.g. bran, ispaghula, methylcellulose, sterculia) 50% for diverticulosis with a history of constipation. 58% N/A E E1 Disease-modifying anti-rheumatic drug (DMARD) 25% with active, disabling rheumatoid disease. 42% N/A E2 Bisphosphonates and vitamin D and calcium 67% in patients taking long-term systemic corticosteroid therapy. 33% N/A E3 Vitamin D and calcium supplement 17% in patients with known osteoporosis and/or previous fragility fracture(s) and/or Bone Mineral Density T-scores more than -2.5 in multiple sites. 75% N/A E4 Bone anti-resorptive or anabolic therapy (e.g. bisphosphonate, strontium ranelate, teriparatide, denosumab) 42% in patients with documented osteoporosis, where no pharmacological or clinical status contraindication exists (Bone Mineral Density T-scores -> 2.5 in multiple sites) and/or previous history of fragility fracture(s). 58% N/A E5 Vitamin D supplement 42% in older people who are housebound or experiencing falls or with osteopenia (Bone Mineral Density T-score is > -1.0 but < -2.5 in multiple sites). 50% N/A E6 Xanthine-oxidase inhibitors (e.g. allopurinol, febuxostat) 50% with a history of recurrent episodes of gout. 50% N/A E7 Folic acid supplement 92% in patients taking methotexate. 33% N/A
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