Osteoporosis: Pharmacologic Therapy for Men and Women Aged 50 Years and Older (NQF 0049)

EMeasure Name Osteoporosis: Pharmacologic Therapy for Men and Women Aged 50 Years and Older EMeasure Id 9FC1F073-6CB2-43CE-9DC8-9C20BC7E844E
Version number 1 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
©  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
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)
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)
Improvement notation
Higher scores indicate better quality
Measurement duration
12 month(s)
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.
Reference
American Gastroenterological Association.  (2003). American Gastroenterological Association Medical Position Statement:  Osteoporosis in Hepatic Disorders.  Gastroenterology 125, pp 937-940.
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.
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.
Reference
American Gastroenterological Association.  (2003). American Gastroenterological Association Medical Position Statement:  Guidelines on Osteoporosis in Gastrointestinal Diseases.  Gastroenterology 124, pp 791-794.
Reference
Cummings SR, Melton LJ 3rd. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002 May 18;359(9319):1761-7.
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.
Reference
National Osteoporosis Foundation. Fast facts. http://www.nof.org/osteoporosis/diseasefacts.htm [Accessed September 27, 2007]
Reference
National Osteoporosis Foundation.  Osteoporosis:  Physician’s Guide to Prevention and Treatment of Osteoporosis.  2003.
Reference
National Institutes of Health. Osteoporosis Prevention, Diagnosis and Therapy. NIH Consensus Statement. March 2000;17:1-45.
Reference
Riggs BL, Melton LJ 3rd. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. 1995 Nov;17(5 Suppl):505S-511S.
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.
Reference
World Health Organization. Prevention and Management of Osteoporosis: Report of a WHO Scientific Group. World Health Organization. Geneva, Switzerland: World Health Organization, 2003.
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