1. Government Frontend Component Guide
  2. Govspeak content

Component

Govspeak content

To display long form text which has been converted from Govspeak

Govspeak is GOV.UK’s extension of Markdown.

This component has no control over markup, which is passed in to the component pre-generated. It only applies CSS/JS.

It applies styling to standard Markdown content, eg; paragraphs, headings and lists. It also applies styling to Govspeak specific markup, like callouts, contacts and highlights.

Some JavaScript behaviours are applied to this component:

  • Progressively enhanced, accessible charts (using Magna Charta, derived from tabular data (see example)
  • Progressively enhanced, accessible embedded YouTube player (see example)

Search for usage of this component on GitHub

How it looks (preview all)

This is a title

This is some body text with a link

How to call this component

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <h2>This is a title</h2>
  <p>This is some body text with <a href=#>a link</a></p>
<% end %>

Accessibility acceptance criteria

  • headings must be part of a correct heading structure for the page
  • text should have a text contrast ratio higher than 4.5:1 against the background colour to meet WCAG AA

Links in the component must:

  • accept focus
  • be focusable with a keyboard
  • be usable with a keyboard
  • indicate when they have focus
  • change in appearance when touched (in the touch-down state)
  • change in appearance when hovered
  • be usable with touch
  • be usable with voice commands
  • have visible text

Other examples

With content (preview)

This is a title

This is some body text with a link

<%= render "govuk_publishing_components/components/govspeak", {
  content: sanitize("<h2>This is a title</h2>
    <p>This is some body text with <a href=#>a link</a></p>
    ")
} %>

Heading levels (preview)

This is a h2 title

This is a h3 title

This is a h4 title

This is a h5 title
This is a h6 title
<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <h2>This is a h2 title</h2>
<h3>This is a h3 title</h3>
<h4>This is a h4 title</h4>
<h5>This is a h5 title</h5>
<h6>This is a h6 title</h6>
<% end %>

Lists (preview)

ordered list:

  1. one
  2. two
  3. three

unordered list:

  • one
  • two
  • three
<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <h2>ordered list:</h2>
<ol>
  <li>one</li>
  <li>two</li>
  <li>three</li>
</ol>
<h2>unordered list:</h2>
<ul>
  <li>one</li>
  <li>two</li>
  <li>three</li>
</ul>
<% end %>

Nested lists (preview)

ordered list:

    • one
    • two
  1. three

unordered list:

    • one
    • two
  • three
<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <h2>ordered list:</h2>
<ol>
  <li>
    <ul>
      <li>one</li>
      <li>two</li>
    </ul>
  </li>
  <li>three</li>
</ol>
<h2>unordered list:</h2>
<ul>
  <li>
    <ul>
      <li>one</li>
      <li>two</li>
    </ul>
  </li>
  <li>three</li>
</ul>
<% end %>

Legislative lists (preview)

ordered list:

  1. one
  2. two
  3. three
<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <h2>ordered list:</h2>
<ol class="legislative-list">
  <li>one</li>
  <li>two</li>
  <li>three</li>
</ol>
<% end %>

Image fractions (preview)

Number - fractions

Pupils should be taught to:

  • recognise, find, name and write fractions 1/3 , 1/4 , 2/4 and 3/4 of a length, shape, set of objects or quantity
  • write simple fractions, for example 1/2 of 6 = 3 and recognise the equivalence of 2/4 and 1/2

Notes and guidance (non-statutory)

Pupils use fractions as ‘fractions of’ discrete and continuous quantities by solving problems using shapes, objects and quantities. They connect unit fractions to equal sharing and grouping, to numbers when they can be calculated, and to measures, finding fractions of lengths, quantities, sets of objects or shapes. They meet 3/4 as the first example of a non-unit fraction.

Pupils should count in fractions up to 10, starting from any number and using the 1/2 and 2/4 equivalence on the number line (for example, 1 1/4 , 1 2/4 (or 1 1/2 ), 1 3/4 , 2). This reinforces the concept of fractions as numbers and that they can add up to more than 1.

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <h3 id="number---fractions-1">Number - fractions</h3>

<p>Pupils should be taught to:</p>

<ul>
<li>recognise, find, name and write fractions <span class="fraction">
  <img alt="1/3" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/1_3-9003d7f3d7cd4433647a5f6525aa7eda.png"></span>
, <span class="fraction">
  <img alt="1/4" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/1_4-b6128849c8da3b46b9cb5a6918cfe084.png"></span>
, <span class="fraction">
  <img alt="2/4" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/2_4-e071530a44f0d7980f3442c23e3edd3b.png"></span>
 and <span class="fraction">
  <img alt="3/4" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/3_4-cded12d0389211f864dcb27e640c64d4.png"></span>
 of a length, shape, set of objects or quantity</li>
  <li>write simple fractions, for example <span class="fraction">
  <img alt="1/2" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/1_2-6e6f542bec97cb8ea3acf39cd25690ee.png"></span>
 of 6 = 3 and recognise the equivalence of <span class="fraction">
  <img alt="2/4" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/2_4-e071530a44f0d7980f3442c23e3edd3b.png"></span>
and <span class="fraction">
  <img alt="1/2" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/1_2-6e6f542bec97cb8ea3acf39cd25690ee.png"></span>
</li>
</ul>
<div class="call-to-action">
  <h4>Notes and guidance (non-statutory)</h4>

  <p>Pupils use fractions as ‘fractions of’ discrete and continuous quantities by solving problems using shapes, objects and quantities. They connect unit fractions to equal sharing and grouping, to numbers when they can be calculated, and to measures, finding fractions of lengths, quantities, sets of objects or shapes. They meet <span class="fraction">
    <img alt="3/4" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/3_4-cded12d0389211f864dcb27e640c64d4.png"></span>
   as the first example of a non-unit fraction.<br><br>
  Pupils should count in fractions up to 10, starting from any number and using the <span class="fraction">
      <img alt="1/2" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/1_2-6e6f542bec97cb8ea3acf39cd25690ee.png"></span>
   and <span class="fraction">
      <img alt="2/4" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/2_4-e071530a44f0d7980f3442c23e3edd3b.png"></span>
    equivalence on the number line (for example, 1<span class="fraction">
      <img alt="1/4" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/1_4-b6128849c8da3b46b9cb5a6918cfe084.png"></span>
  , 1<span class="fraction">
      <img alt="2/4" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/2_4-e071530a44f0d7980f3442c23e3edd3b.png"></span>
   (or 1<span class="fraction">
      <img alt="1/2" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/1_2-6e6f542bec97cb8ea3acf39cd25690ee.png"></span>
  ), 1<span class="fraction">
      <img alt="3/4" height="27" src="https://assets.digital.cabinet-office.gov.uk/government/assets/fractions/3_4-cded12d0389211f864dcb27e640c64d4.png"></span>
  , 2). This reinforces the concept of fractions as numbers and that they can add up to more than 1.
  </p>
</div>
<% end %>

Text fractions (preview)

If an image is not available for a particular fraction, then we'll fallback to text based fraction using sup/sub, like this 1100 example.

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <p>If an image is not available for a particular fraction, then we'll fallback to text based fraction using <code>sup</code>/<code>sub</code>, like this <span class="fraction"><sup>1</sup>&frasl;<sub>100</sub></span> example.</p>
<% end %>

Blockquote (preview)

My quote

about things

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <blockquote>
  <p>My quote</p>
  <p class="last-child">about things</p>
</blockquote>
<% end %>

Tables (preview)

A table with data
Heading 1Heading 2
cell 1cell 2
cell 3cell 4
<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <table>
  <caption>A table with data</caption>
  <thead>
    <tr>
      <th>Heading 1</th><th>Heading 2</th>
    </tr>
  </thead>
  <tbody>
    <tr>
      <td>cell 1</td><td>cell 2</td>
    </tr>
    <tr>
      <td>cell 3</td><td>cell 4</td>
    </tr>
  </tbody>
</table>
<% end %>

Charts (preview)

A table with numerical data
row 110
row 215
<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <table class='js-barchart-table mc-auto-outdent'>
  <caption>A table with numerical data</caption>
  <tbody>
    <tr>
      <td>row 1</td><td>10</td>
    </tr>
    <tr>
      <td>row 2</td><td>15</td>
    </tr>
  </tbody>
</table>
<% end %>

Address (preview)

First line of address
Second line of address
75 This street
United Kindom
Phone: 07123456789

Addresses are generated when using the `$A` markdown pattern.

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <div class="address">
  <div class="adr org fn">
    <p>
      First line of address
      <br>Second line of address
      <br>75 This street
      <br>United Kindom
      <br>Phone: 07123456789
      <br>
    </p>
  </div>
</div>
<p>Addresses are generated when using the `$A` markdown pattern.</p>
<% end %>

Contact (preview)

Media enquiries

2 Marsham Street
London

SW1P 4DF

A comment about the contact

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <div class="contact" id="contact_1017">
  <div class="content">
    <h3>Media enquiries</h3>
    <div class="vcard contact-inner">
      <p class="adr">
        <span class="street-address">2 Marsham Street<br>London</span><br>
        <span class="postal-code">SW1P 4DF</span>
      </p>
      <div class="email-url-number">
        <p class="tel"><span class="type">Press enquiries</span> 020 7XXX XXXX</p>
        <p class="tel"><span class="type">Out of hours</span> 020 7XXX XXXX</p>
      </div>
      <p class="comments">A comment about the contact</p>
    </div>
  </div>
</div>
<% end %>

Contact with surrounding text (preview)

This is a title

Media enquiries

2 Marsham Street
London

SW1P 4DF

A comment about the contact

This is a paragraph.

Media enquiries

2 Marsham Street
London

SW1P 4DF

A comment about the contact

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <h2>This is a title</h2>
<div class="contact" id="contact_1018">
  <div class="content">
    <h3>Media enquiries</h3>
    <div class="vcard contact-inner">
      <p class="adr">
        <span class="street-address">2 Marsham Street<br>London</span><br>
        <span class="postal-code">SW1P 4DF</span>
      </p>
      <div class="email-url-number">
        <p class="tel"><span class="type">Press enquiries</span> 020 7XXX XXXX</p>
        <p class="tel"><span class="type">Out of hours</span> 020 7XXX XXXX</p>
      </div>
      <p class="comments">A comment about the contact</p>
    </div>
  </div>
</div>
<p>This is a paragraph.</p>
<div class="contact" id="contact_1019">
  <div class="content">
    <h3>Media enquiries</h3>
    <div class="vcard contact-inner">
      <p class="adr">
        <span class="street-address">2 Marsham Street<br>London</span><br>
        <span class="postal-code">SW1P 4DF</span>
      </p>
      <div class="email-url-number">
        <p class="tel"><span class="type">Press enquiries</span> 020 7XXX XXXX</p>
        <p class="tel"><span class="type">Out of hours</span> 020 7XXX XXXX</p>
      </div>
      <p class="comments">A comment about the contact</p>
    </div>
  </div>
</div>
<% end %>

Footnotes (preview)

This is a text with a footnote1.

  1. And here is the definition.

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <p>This is a text with a footnote<sup id="fnref:1a"><a href="#fn:1a" class="footnote">1</a></sup>.</p>

<div class="footnotes">
  <ol>
    <li id="fn:1a">
      <p>And here is the definition. <a href="#fnref:1a" class="reversefootnote">&#8617;</a></p>
    </li>
  </ol>
</div>
<% end %>

Rtl block (preview)

قال وزير الخارجية، ويليام هيغ:

مع بدء هذا الشهر الفضيل أتمنى للمسلمين في أنحاء العالم - في آسيا وأفريقيا والشرق الأوسط وأوروبا وغيرها من مناطق العالم - شهر رمضان مبارك.

في المملكة المتحدة يُحتفل بشهر رمضان منذ أجيال عديدة، ونفتخر بروابطنا القوية مع العالم الإسلامي، سواء مع شركائنا المعهودين في الشرق الأوسط أو روابطنا التاريخية المتينة في آسيا وأفريقيا أو مواطنينا المسلمين البريطانيين المفعمين بالحيوية والنشاط.

ordered list

  1. تابع الوزير أليستر بيرت عبر تويتر
  2. تابعنا باللغة العربية عبر
  3. تابعنا باللغة العربية عبر تويتر

unordered list

  • تابع الوزير أليستر بيرت عبر تويتر
  • تابعنا باللغة العربية عبر
  • تابعنا باللغة العربية عبر تويتر
<%= render "govuk_publishing_components/components/govspeak", {
  direction: "rtl"
} do %>
  <p>قال وزير الخارجية، ويليام هيغ:</p>
<blockquote>
  <p>مع بدء هذا الشهر الفضيل أتمنى للمسلمين في أنحاء العالم - في آسيا وأفريقيا والشرق الأوسط وأوروبا وغيرها من مناطق العالم - شهر رمضان مبارك.</p>
  <p class="last-child">في المملكة المتحدة يُحتفل بشهر رمضان منذ أجيال عديدة، ونفتخر بروابطنا القوية مع العالم الإسلامي، سواء مع شركائنا المعهودين في الشرق الأوسط أو روابطنا التاريخية المتينة في آسيا وأفريقيا أو مواطنينا المسلمين البريطانيين المفعمين بالحيوية والنشاط.</p>
</blockquote>
<h2>ordered list</h2>
<ol>
  <li>تابع الوزير أليستر بيرت عبر تويتر </li>
  <li>تابعنا باللغة العربية عبر</li>
  <li>تابعنا باللغة العربية عبر تويتر </li>
</ol>
<h2>unordered list</h2>
<ul>
  <li>تابع الوزير أليستر بيرت عبر تويتر </li>
  <li>تابعنا باللغة العربية عبر</li>
  <li>تابعنا باللغة العربية عبر تويتر </li>
</ul>
<% end %>

With youtube embed (preview)

This content has a YouTube video link, converted to an accessible embedded player by component JavaScript.

Operations: a developer's guide, by Anna Shipman

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <p>This content has a YouTube video link, converted to an accessible embedded player by component JavaScript.</p>
<p><a href="https://www.youtube.com/watch?v=y6hbrS3DheU">Operations: a developer's guide, by Anna Shipman</a></p>
<% end %>

With youtube embed disabled (preview)

This content has a YouTube video link, where the govspeak expansion has been disabled

Operations: a developer's guide, by Anna Shipman

<%= render "govuk_publishing_components/components/govspeak", {
  disable_youtube_expansions: true
} do %>
  <p>This content has a YouTube video link, where the govspeak expansion has been disabled</p>
<p><a href="https://www.youtube.com/watch?v=y6hbrS3DheU">Operations: a developer's guide, by Anna Shipman</a></p>
<% end %>

Statistic headlines (preview)

This includes £5.8 billion Resource DEL and £0.2 billion Capital DEL. In addition, DWP Annually Managed Expenditure (AME) in financial year 2015 to 2016 is £170.5 billion, as forecast by the Office for Budget Responsibility.

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <aside class="stat-headline">
  <p><em>£6bn</em>
  Total Departmental Expenditure Limit (<abbr title="Departmental Expenditure Limit">DEL</abbr>) in financial year 2015 to 2016</p>
</aside>
<p>This includes £5.8 billion Resource <abbr title="Departmental Expenditure Limit">DEL</abbr> and £0.2 billion Capital <abbr title="Departmental Expenditure Limit">DEL</abbr>. In addition, <abbr title="Department for Work and Pensions">DWP</abbr> Annually Managed Expenditure (<abbr title="Annually Managed Expenditure">AME</abbr>) in financial year 2015 to 2016 is £170.5 billion, as forecast by the Office for Budget Responsibility.</p>
<aside class="stat-headline">
  <p>UK employment rate
  <em>74.1%</em>
  between October and December 2015</p>
</aside>
<% end %>

Specialist content (preview)

Bisphosphonates

Bisphosphonates are used to treat osteoporosis, Paget’s disease, and as part of some cancer regimens, particularly for metastatic bone cancer and multiple myeloma. Individual bisphosphonates have different indications (see individual Summaries of Product Characteristics1). The following bisphosphonates are available in the UK:

  • Alendronic acid
  • Ibandronic acid
  • Pamidronate disodium
  • Risedronate sodium
  • Sodium clodronate
  • Zoledronic acid

Osteonecrosis of the external auditory canal

Benign idiopathic osteonecrosis of the external auditory canal is a rare condition that can occur in the absence of antiresorptive therapy and is sometimes associated with local trauma.

Advice for healthcare professionals:

  • The possibility of osteonecrosis of the external auditory canal should be considered in patients receiving bisphosphonates who present with ear symptoms, including chronic ear infections, or in patients with suspected cholesteatoma
  • Possible risk factors include steroid use and chemotherapy, with or without local risk factors such as infection or trauma
  • Patients should be advised to report any ear pain, discharge from the ear, or an ear infection during bisphosphonate treatment
  • Report any cases of osteonecrosis of the external auditory canal suspected to be associated with bisphosphonates or any other medicines, including denosumab, on a Yellow Card

Evidence for an association with bisphosphonate treatment

Evidence from the clinical literature and from cases reported to medicines regulators, including one report received via the UK Yellow Card scheme, supports a causal association between bisphosphonates and osteonecrosis of the external auditory canal. Product information is being updated to include advice for healthcare professionals and patients.

A total of 29 reports indicative of osteonecrosis of the external auditory canal in association with bisphosphonates have been identified worldwide, including 11 cases reported in the clinical literature.2 3 4 5 6 7 8 Cases have been reported with use of both intravenous or oral bisphosphonates for both cancer-related or osteoporosis indications; there is currently insufficient evidence to determine whether there is any increased risk with higher doses used for cancer-related conditions. Most cases were associated with long-term bisphosphonate therapy for 2 years or longer, and most cases had possible risk factors including: steroid use; chemotherapy; and possible local risk factors such as infection, an ear operation, or cotton-bud use. Bilateral osteonecrosis of the external ear canal was reported in some patients, as was osteonecrosis of the jaw.

The number of cases of osteonecrosis of the external auditory canal reported in association with bisphosphonates is low compared with the number of cases reported of bisphosphonate-related osteonecrosis of the jaw, a well-established side effect of bisphosphonates.9

Evidence for an association with denosumab treatment

The available data do not support a causal relation between osteonecrosis of the external auditory canal and denosumab. However, this possible risk is being kept under close review, given that denosumab is known to be associated with osteonecrosis of the jaw.

Article citation: Drug Safety Update volume 9 issue 5 December 2015: 3.

  1. Summaries of Product Characteristics can be found here on the MHRA website or on the website of the European Medicines Agency, depending whether the medicine has a national or European licence, respectively.

  2. Bast F, et al. Bilateral bisphosphonate-associated osteonecrosis of the external ear canal: a rare case. HNO. 2012; 60: 1127–29 [in German].

  3. Froelich K, et al. Bisphosphonate-induced osteonecrosis of the external ear canal: a retrospective study. Eur Arch Otorhinolaryngol 2011; 268: 1219–25.

  4. Kharazmi M, et al. Bisphosphonate-associated osteonecrosis of the auditory canal. Br J Oral Maxillofac Surg 2013; 51: e285–87.

  5. Polizzotto MN, et al. Bisphosphonate-associated osteonecrosis of the auditory canal. Br J Haematol 2006; 132: 114.

  6. Salzman R, et al. Osteonecrosis of the external auditory canal associated with oral bisphosphonate therapy: case report and literature review. Otol Neurotol 2013; 34: 209–13.

  7. Thorsteinsson AL, et al. Bisphosphonate-induced osteonecrosis of the external auditory canal: a case report. J Clin Med Case Reports 2015; 2: 3.

  8. Wickham N, et al. Bisphosphonate-associated osteonecrosis of the external auditory canal. J Laryngol Otol 2013; 127 (suppl 2): S51–53.

  9. Patient reminder cards about the risk of osteonecrosis of the jaw are being introduced for intravenous bisphosphonates and denosumab. The cards will become available at different times for individual products. They are now available for the following products: Prolia (denosumab); Xgeva (denosumab); Aclasta (zoledronic acid); Zometa (zoledronic acid); zoledronic acid 5 mg generics and zoledronic acid 4 mg generics. The cards can be viewed here.

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <h2 id="bisphosphonates">Bisphosphonates</h2>
<p>Bisphosphonates are used to treat osteoporosis, Paget’s disease, and as part of some cancer regimens, particularly for metastatic bone cancer and multiple myeloma. Individual bisphosphonates have different indications (see individual Summaries of Product Characteristics<sup id="fnref:1"><a href="#fn:1" class="footnote">1</a></sup>). The following bisphosphonates are available in the UK:</p>

<ul>
  <li>Alendronic acid</li>
  <li>Ibandronic acid</li>
  <li>Pamidronate disodium</li>
  <li>Risedronate sodium</li>
  <li>Sodium clodronate</li>
  <li>Zoledronic acid</li>
</ul>

<h2 id="osteonecrosis-of-the-external-auditory-canal">Osteonecrosis of the external auditory canal</h2>
<p>Benign idiopathic osteonecrosis of the external auditory canal is a rare condition that can occur in the absence of antiresorptive therapy and is sometimes associated with local trauma.</p>

<div class="call-to-action">
  <p>Advice for healthcare professionals:</p>
  <ul>
    <li>The possibility of osteonecrosis of the external auditory canal should be considered in patients receiving bisphosphonates who present with ear symptoms, including chronic ear infections, or in patients with suspected cholesteatoma</li>
    <li>Possible risk factors include steroid use and chemotherapy, with or without local risk factors such as infection or trauma</li>
    <li>Patients should be advised to report any ear pain, discharge from the ear, or an ear infection during bisphosphonate treatment</li>
    <li>Report any cases of osteonecrosis of the external auditory canal suspected to be associated with bisphosphonates or any other medicines, including denosumab, on a <a rel="external" href="http://www.mhra.gov.uk/yellowcard">Yellow Card</a>
  </li>
  </ul>
</div>

<h2 id="evidence-for-an-association-with-bisphosphonate-treatment">Evidence for an association with bisphosphonate treatment</h2>
<p>Evidence from the clinical literature and from cases reported to medicines regulators, including one report received via the UK Yellow Card scheme, supports a causal association between bisphosphonates and osteonecrosis of the external auditory canal. Product information is being updated to include advice for healthcare professionals and patients.</p>

<p>A total of 29 reports indicative of osteonecrosis of the external auditory canal in association with bisphosphonates have been identified worldwide, including 11 cases reported in the clinical literature.<sup id="fnref:2"><a href="#fn:2" class="footnote">2</a></sup> <sup id="fnref:3"><a href="#fn:3" class="footnote">3</a></sup> <sup id="fnref:4"><a href="#fn:4" class="footnote">4</a></sup> <sup id="fnref:5"><a href="#fn:5" class="footnote">5</a></sup> <sup id="fnref:6"><a href="#fn:6" class="footnote">6</a></sup> <sup id="fnref:7"><a href="#fn:7" class="footnote">7</a></sup> <sup id="fnref:8"><a href="#fn:8" class="footnote">8</a></sup> Cases have been reported with use of both intravenous or oral bisphosphonates for both cancer-related or osteoporosis indications; there is currently insufficient evidence to determine whether there is any increased risk with higher doses used for cancer-related conditions. Most cases were associated with long-term bisphosphonate therapy for 2 years or longer, and most cases had possible risk factors including: steroid use; chemotherapy; and possible local risk factors such as infection, an ear operation, or cotton-bud use. Bilateral osteonecrosis of the external ear canal was reported in some patients, as was osteonecrosis of the jaw.</p>

<p>The number of cases of osteonecrosis of the external auditory canal reported in association with bisphosphonates is low compared with the number of cases reported of bisphosphonate-related osteonecrosis of the jaw, a <a href="https://www.gov.uk/drug-safety-update/denosumab-xgeva-prolia-intravenous-bisphosphonates-osteonecrosis-of-the-jaw-further-measures-to-minimise-risk">well-established side effect of bisphosphonates</a>.<sup id="fnref:9"><a href="#fn:9" class="footnote">9</a></sup></p>

<h2 id="evidence-for-an-association-with-denosumab-treatment">Evidence for an association with denosumab treatment</h2>
<p>The available data do not support a causal relation between osteonecrosis of the external auditory canal and denosumab. However, this possible risk is being kept under close review, given that denosumab is <a href="https://www.gov.uk/drug-safety-update/denosumab-xgeva-prolia-intravenous-bisphosphonates-osteonecrosis-of-the-jaw-further-measures-to-minimise-risk">known to be associated with osteonecrosis of the jaw</a>.</p>

<p>Article citation: Drug Safety Update volume 9 issue 5 December 2015: 3.</p>

<div class="footnotes">
  <ol>
    <li id="fn:1">
      <p>Summaries of Product Characteristics can be found <a rel="external" href="http://www.mhra.gov.uk/spc-pil/index.htm">here on the MHRA website</a> or on the <a rel="external" href="http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landing_page.jsp">website of the European Medicines Agency</a>, depending whether the medicine has a national or European licence, respectively. <a href="#fnref:1" class="reversefootnote"></a></p>
    </li>
    <li id="fn:2">
      <p>Bast F, et al. <a rel="external" href="http://www.ncbi.nlm.nih.gov/pubmed/23202871">Bilateral bisphosphonate-associated osteonecrosis of the external ear canal: a rare case</a>. HNO. 2012; 60: 1127–29 [in German]. <a href="#fnref:2" class="reversefootnote"></a></p>
    </li>
    <li id="fn:3">
      <p>Froelich K, et al. <a rel="external" href="http://www.ncbi.nlm.nih.gov/pubmed?term=Froelich+K%5Bauthor%5D+AND+Bisphosphonate&amp;TransSchema=title&amp;cmd=detailssearch">Bisphosphonate-induced osteonecrosis of the external ear canal: a retrospective study</a>. Eur Arch Otorhinolaryngol 2011; 268: 1219–25. <a href="#fnref:3" class="reversefootnote"></a></p>
    </li>
    <li id="fn:4">
      <p>Kharazmi M, et al. <a rel="external" href="http://www.ncbi.nlm.nih.gov/pubmed/24220454">Bisphosphonate-associated osteonecrosis of the auditory canal</a>. Br J Oral Maxillofac Surg 2013; 51: e285–87. <a href="#fnref:4" class="reversefootnote"></a></p>
    </li>
    <li id="fn:5">
      <p>Polizzotto MN, et al. <a rel="external" href="http://www.ncbi.nlm.nih.gov/pubmed?term=Polizzotto+MN%5Bauthor%5D+AND+Bisphosphonate&amp;TransSchema=title&amp;cmd=detailssearch">Bisphosphonate-associated osteonecrosis of the auditory canal</a>. Br J Haematol 2006; 132: 114. <a href="#fnref:5" class="reversefootnote"></a></p>
    </li>
    <li id="fn:6">
      <p>Salzman R, et al. <a rel="external" href="http://www.ncbi.nlm.nih.gov/pubmed/23444468">Osteonecrosis of the external auditory canal associated with oral bisphosphonate therapy: case report and literature review</a>. Otol Neurotol 2013; 34: 209–13. <a href="#fnref:6" class="reversefootnote"></a></p>
    </li>
    <li id="fn:7">
      <p>Thorsteinsson AL, et al. <a rel="external" href="http://www.avensonline.org/fulltextarticles/jcmcr-2332-4120-02-0007.html">Bisphosphonate-induced osteonecrosis of the external auditory canal: a case report</a>. J Clin Med Case Reports 2015; 2: 3. <a href="#fnref:7" class="reversefootnote"></a></p>
    </li>
    <li id="fn:8">
      <p>Wickham N, et al. <a rel="external" href="http://www.ncbi.nlm.nih.gov/pubmed?term=Wickham%5Bauthor%5D+AND+Bisphosphonate&amp;TransSchema=title&amp;cmd=detailssearch">Bisphosphonate-associated osteonecrosis of the external auditory canal</a>. J Laryngol Otol 2013; 127 (suppl 2): S51–53. <a href="#fnref:8" class="reversefootnote"></a></p>
    </li>
    <li id="fn:9">
      <p>Patient reminder cards about the risk of osteonecrosis of the jaw are being introduced for intravenous bisphosphonates and denosumab. The cards will become available at different times for individual products. They are now available for the following products: Prolia (denosumab); Xgeva (denosumab); Aclasta (zoledronic acid); Zometa (zoledronic acid); zoledronic acid 5 mg generics and zoledronic acid 4 mg generics. The cards can be viewed <a href="https://www.gov.uk/drug-safety-update/denosumab-xgeva-prolia-intravenous-bisphosphonates-osteonecrosis-of-the-jaw-further-measures-to-minimise-risk">here</a>. <a href="#fnref:9" class="reversefootnote"></a></p>
    </li>
  </ol>
</div>
<% end %>

Attachment link (preview)

Attachment link component rendered within Govspeak

A reference to my Attachment (PDF, 1 KB, 2 pages) that is in my paragraph.

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <p>
  A reference to my
  <%= render "govuk_publishing_components/components/attachment_link",
      attachment: { url: "https://example.com/file.pdf",
                    title: "Attachment",
                    file_size: 1024,
                    content_type: "application/pdf",
                    number_of_pages: 2 }
  %>
  that is in my paragraph.
</p>
<% end %>

Attachment (preview)

Attachment component rendered within Govspeak

An attachment as a block

Attachment

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <p>An attachment as a block</p>

<%= render "govuk_publishing_components/components/attachment",
    attachment: { url: "https://example.com/file.odt",
                  title: "Attachment",
                  file_size: 1024,
                  content_type: "application/vnd.oasis.opendocument.text" }
%>
<% end %>

Inline attachment (preview)

Legacy inline attachment embed used by Whitehall and Specialist Publisher

testing my attachment testing (CSV, 65.4KB) works in the middle of copy.

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <p>testing my attachment <span class="inline-attachment" id="attachment_1399340">
  <a href="/government/uploads/system/uploads/attachment_data/file/498071/PHE_Payments_over__25k_Jun_15.csv">testing</a>
  (<span class="type"><abbr title="Comma-separated Values">CSV</abbr></span>, <span class="file-size">65.4KB</span>)</span> works in the middle of copy.
</p>
<% end %>

Whitehall block attachments (preview)

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PDF Attachment

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Order a copy

Previewable online example

Fly-tipping incidents and actions reported by local authorities in 2014 to 2015

This file is in an OpenDocument format

This file may not be suitable for users of assistive technology. Request a different format.

If you use assistive technology and need a version of this document in a more accessible format, please email defra.helpline@defra.gsi.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <section class="attachment embedded" id="attachment_1399345">
  <div class="attachment-thumb">
    <a aria-hidden="true" class="thumbnail" href="https://www.gov.uk/government/publications/minimum-wage-jobs-in-ashfield-local-authority-since-2009"><img alt="" src="https://assets.digital.cabinet-office.gov.uk/government/uploads/system/uploads/attachment_data/file/496127/thumbnail_LPC_FoI_09.12.15_NMW_jobs_Ashfield_LA.pdf.png"></a>
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</section>
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  </div>
</section>
<section class="attachment embedded" id="attachment_1105176">
  <div class="attachment-thumb">
    <a aria-hidden="true" class="thumbnail" href="https://www.gov.uk/government/publications/post-legislative-memorandum-the-equality-act-2010"><img alt="" src="https://assets.digital.cabinet-office.gov.uk/government/uploads/system/uploads/attachment_data/file/441838/thumbnail_Memo_to_Women_Equalities.pdf.png"></a>
  </div>
  <div class="attachment-details">
    <h2 class="title"><a href="https://www.gov.uk/government/publications/post-legislative-memorandum-the-equality-act-2010">File attachment with additional metadata</a></h2>
    <p class="metadata">
      <span class="references">
      Ref: ISBN <span class="isbn">9781474121767</span>, <span class="command_paper_number">CM 9101</span>
      </span>
      <span class="type"><abbr title="Portable Document Format">PDF</abbr></span>, <span class="file-size">2.02MB</span>, <span class="page-length">86 pages</span>
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      <a class="order_url" title="Order a copy of the publication" href="https://www.gov.uk/how-to-buy-printed-copies-of-official-documents%20">Order a copy</a>
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</section>
<section class="attachment embedded" id="attachment_1399348">
  <div class="attachment-thumb">
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  </div>
  <div class="attachment-details">
    <h2 class="title">Previewable online example</h2>
    <p class="metadata">
      <span class="preview">
      <strong>
      <a href="https://www.gov.uk/government/publications/phe-spend-over-25000-june-2015">View online</a>
      </strong>
      </span>
      <span class="download">
      <a href="https://www.gov.uk/government/publications/phe-spend-over-25000-june-2015">
      <strong>Download CSV</strong>
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<section class="attachment embedded" id="attachment_1243761">
  <div class="attachment-thumb">
    <a aria-hidden="true" class="thumbnail" href="https://www.gov.uk/government/statistical-data-sets/env24-fly-tipping-incidents-and-actions-taken-in-england"><img alt="" src="https://assets.digital.cabinet-office.gov.uk/government/assets/pub-cover-spreadsheet-471052e0d03e940bbc62528a05ac204a884b553e4943e63c8bffa6b8baef8967.png"></a>
  </div>
  <div class="attachment-details">
    <h2 class="title"><a aria-describedby="attachment-1243761-accessibility-help" href="https://www.gov.uk/government/statistical-data-sets/env24-fly-tipping-incidents-and-actions-taken-in-england">Fly-tipping incidents and actions reported by local authorities in 2014 to 2015</a></h2>
    <p class="metadata">
      <span class="type"><abbr title="OpenDocument Spreadsheet">ODS</abbr></span>, <span class="file-size">173KB</span>
    </p>
    <p class="opendocument-help">
      This file is in an <a rel="external" href="https://en.wikipedia.org/wiki/OpenDocument_software">OpenDocument</a> format
    </p>
    <div data-module="toggle" class="accessibility-warning" id="attachment-1243761-accessibility-help">
      <h2>This file may not be suitable for users of assistive technology.
        <a class="toggler" href="#attachment-1243761-accessibility-request" data-controls="attachment-1243761-accessibility-request" data-expanded="false">Request a different format.</a>
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    <h2 class="title"><a href="https://www.gov.uk/government/publications/summer-budget-2015/summer-budget-2015">Summer Budget 2015</a></h2>
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<section class="attachment hosted-externally" id="attachment_1425055">
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    <h2 class="title"><a rel="external" href="http://example.com">An external link</a></h2>
    <p class="metadata">
      <span class="url">http://example.com</span>
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</section>
<section class="attachment hosted-externally" id="attachment_1425056">
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    </p>
  </div>
</section>
<% end %>

Whitehall block attachment rtl (preview)

Attachments rendered by govspeak extensions within Whitehall

مستقبل الغذاء والزراعة: موجز تنفيذي

هذا المف قد لا يكون مناسبا لمستخدمي التكنولوجيا المساعدة على القراءة

لاستلام وثيقة مكتوبة بشكل آخر، كلغة بريل أو وثيقة صوتية أو أي نوع آخر من الوثائق، يرجى إرسال رسالة إلكترونية إلى enquiries@bis.gsi.gov.uk مع كتابة عنوانك ورقم هاتفك إلى جانب عنوان الوثيقة المطلوبة ("{title}"), and its reference (Unique reference: BIS/11/924)

<%= render "govuk_publishing_components/components/govspeak", {
  direction: "rtl"
} do %>
  <section class="attachment embedded" id="attachment_514218">
  <div class="attachment-thumb">
    <a aria-hidden="true" class="thumbnail" href="https://www.gov.uk/government/publications/future-of-food-and-farming.ar"><img alt="" src="https://assets-origin.integration.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/288236/thumbnail_11-924-future-of-food-and-farming-summary-arabic.pdf.png"></a>
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    <p class="metadata">
      <span class="references">
      إشارة: <span class="unique_reference">BIS/11/924</span>
      </span>
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    <div data-module="toggle" class="accessibility-warning" id="attachment-514218-accessibility-help">
      <h2>هذا المف قد لا يكون مناسبا لمستخدمي التكنولوجيا المساعدة على القراءة
        <a class="toggler" href="#attachment-514218-accessibility-request" data-controls="attachment-514218-accessibility-request" data-expanded="false" role="button" aria-controls="attachment-514218-accessibility-request" aria-expanded="false">طلب الوثيقة بشكل آخر</a>
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      <p id="attachment-514218-accessibility-request" class="js-hidden" aria-live="polite" role="region">
        لاستلام وثيقة مكتوبة بشكل آخر، كلغة بريل أو وثيقة صوتية أو أي نوع آخر من الوثائق، يرجى إرسال رسالة إلكترونية إلى <a href="mailto:enquiries@bis.gsi.gov.uk?body=Details%20of%20document%20required%3A%0A%0A%20%20Title%3A%20%D9%85%D8%B3%D8%AA%D9%82%D8%A8%D9%84%20%D8%A7%D9%84%D8%BA%D8%B0%D8%A7%D8%A1%20%D9%88%D8%A7%D9%84%D8%B2%D8%B1%D8%A7%D8%B9%D8%A9%3A%20%D9%85%D9%88%D8%AC%D8%B2%20%D8%AA%D9%86%D9%81%D9%8A%D8%B0%D9%8A%0A%20%20Original%20format%3A%20pdf%0A%20%20Unique%20reference%3A%20BIS%2F11%2F924%0A%0APlease%20tell%20us%3A%0A%0A%20%201.%20What%20makes%20this%20format%20unsuitable%20for%20you%3F%0A%20%202.%20What%20format%20you%20would%20prefer%3F%0A%20%20%20%20%20%20&amp;subject=Request%20for%20%27%D9%85%D8%B3%D8%AA%D9%82%D8%A8%D9%84%20%D8%A7%D9%84%D8%BA%D8%B0%D8%A7%D8%A1%20%D9%88%D8%A7%D9%84%D8%B2%D8%B1%D8%A7%D8%B9%D8%A9%3A%20%D9%85%D9%88%D8%AC%D8%B2%20%D8%AA%D9%86%D9%81%D9%8A%D8%B0%D9%8A%27%20in%20an%20alternative%20format">enquiries@bis.gsi.gov.uk</a> مع كتابة عنوانك ورقم هاتفك إلى جانب عنوان الوثيقة المطلوبة ("{title}"), and its reference (Unique reference: BIS/11/924)
      </p>
    </div>
  </div>
</section>
<% end %>

Example (preview)

Example This is an indented example block.
It may span multiple lines, contain links.

It may even span multiple paragraphs.

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <div class="example">
  <p>
    <strong>Example</strong>
    This is an indented example block.<br/>
    It may span multiple lines, <a href="#">contain links</a>.
  </p>
  <p>
    It may even span multiple paragraphs.
  </p>
</div>
<% end %>

Call to action (preview)

Call to action

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <div class="call-to-action">
  <p>Call to action</p>
</div>
<% end %>

Information callout (preview)

If you drilled a tunnel straight through the Earth and jumped in, it would take you exactly 42 minutes and 12 seconds to get to the other side.

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <div class="application-notice info-notice">
  <p>
    If you drilled a tunnel straight through the Earth and jumped in, it would take
    you exactly 42 minutes and 12 seconds to get to the other side.
  </p>
</div>
<% end %>

Warning callout (preview)

The water in the mouth of a blue whale weighs more than its body.

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <div class="application-notice help-notice">
  <p>
    The water in the mouth of a blue whale weighs more than its body.
  </p>
</div>
<% end %>

Advisory (preview)

This is a very important message or warning

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <h3 role="note" aria-label="Important" class="advisory">
  <span>This is a very important message or warning</span>
</h3>
<% end %>

Form download (preview)

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <div class="form-download">
  <p><a href="http://example.com/" title="Example form" rel="external">An example form download link.</a></p>
</div>
<% end %>

Steps (preview)

  1. Add numbers.

  2. Check numbers.

  3. Love numbers.

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <ol class="steps"> <li> <p>Add numbers.</p> </li> <li> <p>Check numbers.</p> </li> <li> <p>Love numbers.</p> </li> </ol><% end %>

Highlight answer (preview)

The VAT rate is 20%

In the 2017 to 2018 tax year, the savings limit for Junior ISAs is £4,128

In the 2017 to 2018 tax year, the maximum you can save in ISAs is £20,000

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <div class="highlight-answer">
  <p>The VAT rate is <em>20%</em></p>
</div>
<div class="highlight-answer">
  <p>In the 2017 to 2018 tax year, the savings limit for Junior <abbr title="Individual Savings Accounts">ISAs</abbr> is <em>£4,128</em></p>
</div>
<div class="highlight-answer">
  <p>In the 2017 to 2018 tax year, the maximum you can save in <abbr title="Individual Savings Accounts">ISAs</abbr> is <em>£20,000</em></p>
</div>
<% end %>

Place (preview)

This is a place

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <div class="place">
  <p>This is a place</p>
</div>
<% end %>

Summary (preview)

This is a summary

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <div class="summary">
  <p>This is a summary</p>
</div>
<% end %>

Button (preview)

<%= render "govuk_publishing_components/components/govspeak", {
} do %>
  <a href="#" class="button button-start" role="button">
  Start now
</a>
<% end %>