eMeasure Name | Osteoporosis: Pharmacologic Therapy for Men and Women Aged 50 Years and Older | eMeasure Id | 9FC1F073-6CB2-43CE-9DC8-9C20BC7E844E |
Version number | 1 | eMeasure Set Id | 1E690B25-8961-4EA8-B8FF-82346524F0FF |
Available Date | No information | Measurement Period | January 1, 20xx through December 31, 20xx |
Measure Steward | National Committee for Quality Assurance | ||
Endorsed by | National Quality Forum | ||
Description | Percentage of patients aged 50 years and older with a diagnosis of osteoporosis who were prescribed pharmacologic therapy within 12 months | ||
Copyright | © 2011 American Medical Association and/or National Committee for Quality Assurance. All Rights Reserved |
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Measure scoring | Proportion | ||
Measure type | Process | ||
Stratification | None |
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Risk Adjustment | None |
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Data Aggregation | |||
Rationale | Pharmacologic therapy is an evidence-based recommendation for the treatment of osteoporosis. In the U.S., an estimated 10 million people have osteoporosis, and another 34 million are at risk for osteoporosis due to low bone mass. (National Osteoporosis Foundation, 2007) Osteoporotic fractures are associated with significant morbidity and mortality; ten to twenty percent of all those who suffer a hip fracture will die in the six months following the fracture, and 50 percent will be unable to walk without assistance. (Riggs, 1995) Women are disproportionately affected by osteoporosis. The World Health Organization defines osteoporosis as a "systemic skeletal disease characterized by low bone density and micro-architectural deterioration of bone tissue," which causes fragile bones and increases the risk of fractures (especially in the hip, spine, and wrist). (World Health Organization, 2003) Those who suffer an osteoporotic fracture have an increased risk for a second fracture. For example, those with a vertebral fracture are at a five times greater risk of suffering a second vertebral fracture within one year. (Lindsay, 2001) A 2004 Surgeon General report recommended that Americans who suffer an osteoporotic fracture should be tested and treated in order to prevent a second fracture. Fragility fractures are considered one of the most serious warning signs of osteoporosis or low bone density and warrant further evaluation, including bone mineral density testing, which is the "gold standard" of osteoporosis and fracture risk testing. (USDHHS, 2004) |
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Clinical Recommendation Statement | Agents approved by the FDA for osteoporosis prevention and/or treatment include (in alphabetical order) bisphosphonates (alendronate, ibandronate, risedronate), salmon calcitonin, estrogen, raloxifene, and teriparatide. All act by reducing bone resorption, except for teriparatide, which has anabolic effects on bone. Although estrogen is not approved for treatment of osteoporosis, there is level 1 evidence for its efficacy in reducing vertebral fractures, nonvertebral fractures, and hip fractures. Level 1 evidence of efficacy in reducing the risk of vertebral fractures is available for all the agents approved for treatment of osteoporosis (bisphosphonates, calcitonin, raloxifene, and teriparatide). Prospective trials have demonstrated the effectiveness of bisphosphonates and teriparatide in reducing the risk of nonvertebral fractures (level 1), but only bisphosphonates have been shown to reduce the risk of hip fractures in prospective controlled trials (level 1). (AACE1) US Food and Drug Administration-approved pharmacologic options for osteoporosis prevention and/or treatment of postmenopausal osteoporosis include, in alphabetical order: bisphosphonates (alendronate, alendronate plus D, ibandronate, and risedronate, risedronate with 500 mg of calcium as the carbonate), calcitonin, estrogens (estrogens and/or hormone therapy), parathyroid hormone [PTH (1-34), teriparatide], and selective estrogen receptor modulators or SERMS (raloxifene). (NOF5) The U.S. Preventive Services Task Force (USPSTF) recommends that women aged 65 and older be screened routinely for osteoporosis. There is good evidence that the risk for osteoporosis and fracture increases with age and other factors; bone density measurements accurately predict the risk for fractures in the short-term; treating asymptomatic women with osteoporosis reduces their risk for fracture. (USPSTF, 2002) |
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Improvement notation | Higher scores indicate better quality |
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Measurement duration | 12 month(s) |
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Reference | American Association of Clinical Endocrinologists. Medical Guidelines for Clinical Practice for the Prevention and Treatment of Postmenopausal Osteoporosis. 2001 Edition, with selected updates for 2003. |
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Reference | American Gastroenterological Association. (2003). American Gastroenterological Association Medical Position Statement: Osteoporosis in Hepatic Disorders. Gastroenterology 125, pp 937-940. |
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Reference | American Association of Clinical Endocrinologists. Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hypogonadism in Adult Male Patients. 2002 Update. Endocrine Practice 2002: 8, 6, pp 439-456. |
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Reference | American College of Rheumatology. Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. 2001 Update. Arthritis & Rheumatism 2001: 44, 7, pp 1496-1503. |
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Reference | American Gastroenterological Association. (2003). American Gastroenterological Association Medical Position Statement: Guidelines on Osteoporosis in Gastrointestinal Diseases. Gastroenterology 124, pp 791-794. |
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Reference | Cummings SR, Melton LJ 3rd. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002 May 18;359(9319):1761-7. |
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Reference | Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285:320-323. |
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Reference | National Osteoporosis Foundation. Fast facts. http://www.nof.org/osteoporosis/diseasefacts.htm [Accessed September 27, 2007] |
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Reference | National Osteoporosis Foundation. Osteoporosis: Physician's Guide to Prevention and Treatment of Osteoporosis. 2003. |
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Reference | National Institutes of Health. Osteoporosis Prevention, Diagnosis and Therapy. NIH Consensus Statement. March 2000;17:1-45. |
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Reference | Riggs BL, Melton LJ 3rd. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. 1995 Nov;17(5 Suppl):505S-511S. |
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Reference | U.S. Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General, 2004. |
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Reference | World Health Organization. Prevention and Management of Osteoporosis: Report of a WHO Scientific Group. World Health Organization. Geneva, Switzerland: World Health Organization, 2003. |
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Definition | Initial Patient Population(s): All patients 50 years of age and older during the measurement period |
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Definition | Denominator(s): Patients in the initial population with a diagnosis of osteoporosis and an inpatient or ambulatory encounter during the measurement period |
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Definition | Denominator Exclusion(s): N/A |
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Definition | Numerator(s): The number of patients who were prescribed pharmacologic therapy during the measurement period |
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Definition | Denominator Exception(s): . Documentation of medical reason(s) for not prescribing pharmacologic therapy for osteoporosis . Documentation of patient reason(s) for not prescribing pharmacologic therapy for osteoporosis . Documentation of system reason(s) for not prescribing pharmacologic therapy for osteoporosis |
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Guidance | |||
Supplemental Data Elements | Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)". |
Measure set | CLINICAL QUALITY MEASURE SET 2011-2012 |