Osteoporosis: Management Following Fracture of Hip, Spine or Distal radius for Men and Women Aged 50 Years and Older (NQF 0048)

EMeasure Name Osteoporosis: Management Following Fracture of Hip, Spine or Distal radius for Men and Women Aged 50 Years and Older EMeasure Id 0647A1D3-5CB5-428C-8056-69C0B272527F
Version number 1 Set Id 71A28FB0-ED7A-460C-BC0D-9BC69D945FD9
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 or older with fracture of the hip, spine or distal radius that had a central dual-energy X-ray absorptiometry measurement ordered or performed or pharmacologic therapy prescribed.
Copyright
© 2010 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
Patients with a history of fracture should have a baseline bone mass measurement and/or receive treatment for osteoporosis. Given that the majority of osteoporotic fractures occur in patients with a diagnosis of osteoporosis by bone mass measurement, exclusion of osteoporosis by bone mass testing does not preclude treatment of osteoporosis in a patient with a history of fracture. There is a high degree of variability and consensus by experts of what constitutes a fragility fracture and predictor of an underlying problem of osteoporosis. The work group determined that only those fractures, which have the strongest consensus and evidence that they are predictive of osteoporosis, should be included in the measure at this time. We anticipate that the list of fractures will expand as further evidence is published supporting the inclusion of other fractures.
Clinical Recommendation Statement
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 measurement should be performed in all women 40 years old or older who have sustained a fracture. (AACE1)

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

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) 

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 (NOF5)
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
Guidance

Table of Contents


Population criteria

Data criteria (QDS Data Elements)

Summary Calculation

Calculation is generic to all measures:



Measure set CLINICAL QUALITY MEASURE SET 2011-2012