Osteoporosis: Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older (NQF 0046)

eMeasure Name Osteoporosis: Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older eMeasure Id 3A53DC97-3817-4148-AFC7-A7629D692045
Version number 1 eMeasure Set Id D89FEFDD-E333-46FC-B2EA-A5E193B25B79
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 female patients aged 65 years and older who have a central dual-energy X-ray absorptiometry measurement ordered or performed at least once since age 60 or pharmacologic therapy prescribed within 12 months.
Copyright
©  2011 American Medical Association and/or National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
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)  Primary osteoporosis often follows menopause in women, while medications or other medical conditions or diseases can cause secondary 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.  More than three-quarters of those who suffer a hip fracture are women, and 80 percent of those with osteoporosis are women. (Cummings, 2002)

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 warrants further evaluation, including bone mineral density testing, which is the "gold standard" of osteoporosis and fracture risk testing. (USDHHS, 2004)
Clinical Recommendation Statement
The U.S. Preventive Services Task Force (USPSTF) recommends that women aged 65 and older be screened routinely for osteoporosis. (B Recommendation) (USPSTF4)

The USPSTF recommends that routine screening begin at age 60 for women at increased risk for osteoporotic fractures. Use of risk factors, particularly increasing age, low weight, and non-use of estrogen replacement, to screen younger women may identify high-risk women. (B Recommendation) (USPSTF)

BMD measurement should be performed in all women beyond 65 years of age. Dual x-ray absorptiometry of the lumbar spine and proximal femur provides reproducible values at important sites of osteoporosis-associated fracture. These sites are preferred for baseline and serial measurements. (AACE1)

The most important risk factors for osteoporosis-related fractures are a prior low-trauma fracture as an adult and a low BMD in patients with or without fractures. (AACE1) 
BMD testing should be performed on:
. All women aged 65 and older regardless of risk factors
. Younger postmenopausal women with one or more risk factors (other than being white, postmenopausal, and female)
. Postmenopausal women who present with fractures 

The decision to test for BMD should be based on an individual's risk profile. Testing is never indicated unless the results could influence a treatment decision. (NOF5)

Markers of greater osteoporosis and fracture risk include older age, hypogonadism, corticosteroid therapy, and established cirrhosis. (Level B Evidence) (AGA6)

The single most powerful predictor of a future osteoporotic fracture is the presence of previous such fractures. (AGA3)

Pharmacologic therapy should be initiated to reduce fracture risk in women with:
. BMD T-scores below -2.0 by central dual x-ray absorptiometry (DXA) with no risk factors
. BMD T-scores below -1.5 by central dual x-ray absorptiometry (DXA) with one or more risk factors
. A prior vertebral or hip fracture (NOG5)

The decision to measure bone density should follow an individualized approach. It should be considered when it will help the patient decide whether to institute treatment to prevent osteoporotic fracture. It should also be considered in patients receiving glucocorticoid therapy for 2 months or more and patients with other conditions that place them at high risk for osteoporotic fracture. (NIH2)

The most commonly used measurement to diagnose osteoporosis and predict fracture risk is based on assessment of BMD by dual-energy X-ray absorptiometry (DXA). (NIH2) 

Measurements of BMD made at the hip predict hip fracture better than measurements made at other sites while BMD measurement at the spine predicts spine fracture better than measures at other sites. (NIH2)
Improvement notation
Higher scores indicate better quality
Measurement duration
12 month(s)
Reference
1 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.
Reference
2 National Institutes of Health. Osteoporosis Prevention, Diagnosis and Therapy. NIH Consensus Statement. March 2000;17:1-45.
Reference
3 American Gastroenterological Association.  (2003). American Gastroenterological Association Medical Position Statement:  Guidelines on Osteoporosis in Gastrointestinal Diseases.  Gastroenterology 124, pp 791-794.
Reference
4 U.S. Preventive Services Task Force. Screening for Osteoporosis in Postmenopausal Women.  Agency for Healthcare Research and Quality. 2002 Update.
Reference
5 National Osteoporosis Foundation.  Osteoporosis:  Physician's Guide to Prevention and Treatment of Osteoporosis.  2003
Reference
6 American Gastroenterological Association.  (2003). American Gastroenterological Association Medical Position Statement:  Osteoporosis in Hepatic Disorders.  Gastroenterology 125, pp 937-940.
Reference
7 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.
Reference
8 American College of Rheumatology. Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.  2001 Update.  Arthritis & Rheumatism 2001: 44, 7, pp 1496-1503.
Definition
Initial Patient Population(s): All female patients aged 65 years and older during measurement period
Definition
Denominator(s): Patients in the initial population who had an outpatient encounter during the measurement period
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): The number of patients who had a central Dual-energy X-ray Absorptiometry (DXA) measurement ordered or performed at least once since age 60 or pharmacologic therapy prescribed during the measurement period
Definition
Denominator Exception(s): 
E1: Documentation of medical reason(s) for not ordering or performing a central Dual-energy X-ray Absorptiometry (DXA) measurement at least once since age 60 or not prescribing pharmacologic therapy during the measurement period
E2:Documentation of patient reason(s) for not ordering or performing a central DXA measurement at least once since age 60 or not prescribing pharmacologic therapy during the measurement period
E3:Documentation of system reason(s) for not ordering or performing a central DXA measurement at least once since age 60  or not prescribing pharmacologic therapy during the measurement period
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)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012