Skip to main content

The AHRQ National Quality Measures Clearinghouse (NQMC, qualitymeasures.ahrq.gov) Web site will not be available after July 16, 2018 because federal funding
through AHRQ will no longer be available to support the NQMC as of that date. For additional information, read our full announcement.
  • Measure Summary
  • NQMC:009321
  • Jul 2013

Diagnosis and treatment of osteoporosis: percentage of patients who were assessed for risk factors for osteoporosis during an annual preventive visit.

Florence R, Allen S, Benedict L, Compo R, Jensen A, Kalogeropoulou D, Kearns A, Larson S, Mallen E, O'Day K, Peltier A, Webb B. Diagnosis and treatment of osteoporosis. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Jul. 87 p. [210 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients 18 years and older who were assessed for risk factors for osteoporosis during an annual preventive visit.

Rationale

The priority aim addressed by this measure is to increase percentage of patients age 18 years and older who are evaluated for osteoporosis risk factors during an annual preventive visit.

Osteoporosis is a generalized skeletal disorder characterized by compromised bone strength and deterioration of bone quality, often leading to fragility (low trauma) fractures. The World Health Organization (WHO) defines osteoporosis as a bone density of 2.5 standard deviations or more below a reference group of young Caucasian females (WHO, 2004). A low bone mass is frequently found, but not required, for the diagnosis. (A fragility fracture, regardless of the bone mass, necessitates the diagnosis.) Osteoporosis is by far the most common bone disease (WHO, 2004). Osteoporosis can be a primary disorder or can be caused by a host of other factors (e.g., diseases, lifestyle, medications, etc.). The impact of this disorder is massive in terms of cost, morbidity and mortality. An estimated 1.5 million individuals suffer a fragility fracture annually (Riggs et al., 1998). An estimated 40% of women and 25% to 33% of men during their lifetime will suffer a hip, spine or wrist fracture in their lifetime (Binkley et al., 2006). Projections indicate a two- to threefold increase in osteoporosis by 2040 (U.S. Preventive Services Task Force, 2012).

The major challenges facing this field currently include low rates of initial screening with dual-energy X-ray absorptiometry (DXA), lack of initial treatment in cases with a high fracture risk, and poor adherence with prescribed treatment.

Evidence for Rationale

Binkley N, Bilezikian JP, Kendler DL, Leib ES, Lewiecki EM, Petak SM, International Society for Clinical Densitometry. Official positions of the International Society for Clinical Densitometry and Executive Summary of the 2005 Position Development Conference. J Clin Densitom. 2006 Jan-Mar;9(1):4-14. PubMed External Web Site Policy

Florence R, Allen S, Benedict L, Compo R, Jensen A, Kalogeropoulou D, Kearns A, Larson S, Mallen E, O'Day K, Peltier A, Webb B. Diagnosis and treatment of osteoporosis. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Jul. 87 p. [210 references]

Riggs BL, O'Fallon WM, Muhs J, O'Connor MK, Kumar R, Melton LJ. Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women. J Bone Miner Res. 1998 Feb;13(2):168-74. PubMed External Web Site Policy

World Health Organization (WHO). WHO scientific group on the assessment of osteoporosis at primary health care level. Summary Meeting Report. Brussels (Belgium): World Health Organization (WHO); 2004 May 5-7. 17 p.

Primary Health Components

Osteoporosis; risk factors; preventive care visit

Denominator Description

Number of patients age 18 years and older with a preventive visit in the last 12 months (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients age 18 years and older who were assessed for risk factors for osteoporosis during an annual preventive visit

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence

Additional Information Supporting Need for the Measure

  • Of the types of fractures, the most devastating effects are from hip fractures. Most of these occur after a fall, which are more frequent with aging. The one-year mortality rate of a hip fracture is approximately 28% in women and 35% in men (U.S. Department of Health and Human Services, 2004). Some, but not all, of these deaths would be avoided with preventive interventions. Twenty-five percent of these patients will become disabled, and many will require long-term nursing home placement (Ray, 1997). Given the aging population, the frequency, cost and burden of fractures will continue to increase.
  • Annual direct care expenditures for osteoporotic fractures ranged from $12.2 billion to $17.9 billion in 1999. This constitutes 7% of total health care costs for women over the age of 45 (Hoerger, 1999).
  • It is estimated that 50% of women over age 50 will develop a fracture in their remaining lifetime and the annualized risk increases with age. Twenty-five percent of women over age 50 will experience an osteoporotic vertebral fracture, so that by age 75 more than one in three women has sustained at least one vertebral fracture.

Evidence for Additional Information Supporting Need for the Measure

Florence R, Allen S, Benedict L, Compo R, Jensen A, Kalogeropoulou D, Kearns A, Larson S, Mallen E, O'Day K, Peltier A, Webb B. Diagnosis and treatment of osteoporosis. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Jul. 87 p. [210 references]

U.S. Department of Health and Human Services (DHHS), Office of the Surgeon General. Bone health and osteoporosis: a report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services (DHHS); 2004.

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Female (only)

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Staying Healthy

IOM Domain

Effectiveness

Case Finding Period

The time frame pertaining to data collection is monthly, quarterly, semi-annually or annually.

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of patients age 18 years and older with a preventive visit in the last 12 months

Population Definition: Female patients age 18 years and older.

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Number of patients age 18 years and older who were assessed for risk factors for osteoporosis during an annual preventive visit

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Electronic health/medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Percentage of patients who were assessed for risk factors for osteoporosis during an annual preventive visit.

Measure Collection Name

Diagnosis and Treatment of Osteoporosis

Submitter

Institute for Clinical Systems Improvement - Nonprofit Organization

Developer

Institute for Clinical Systems Improvement - Nonprofit Organization

Funding Source(s)

The Institute for Clinical Systems Improvement's (ICSI's) work is funded by the annual dues of the member medical groups and five sponsoring health plans in Minnesota and Wisconsin.

Composition of the Group that Developed the Measure

Work Group Members: Robert Florence, MD, FACP, CDD (Work Group Leader) (Allina Medical Clinic) (Internal Medicine); Luke Benedict, MD (Allina Medical Clinic) (Endocrinology); Sarah Larson (Allina Medical Clinic) (Radiology); Kathryn O'Day, MD (Allina Medical Clinic) (Endocrinology); Renee Compo, RN, CNP (HealthPartners Medical Group and Regions Hospital) (Nursing); Amanda Jensen, RTR (HealthPartners Medical Group and Regions Hospital) (Radiology); Dionysia Kalogeropoulou, MD (HealthPartners Medical Group and Regions Hospital) (Endocrinology); Amber Peltier, PharmD (HealthPartners Medical Group and Regions Hospital) (Pharmacy); Ann Kearns, MD, PhD (Mayo Clinic) (Endocrinology); Sharon Allen, MD (University of Minnesota Physicians) (Family Medicine); Emily Mallen, MBA (Institute for Clinical Systems Improvement [ICSI]) (Project Manager); Beth Webb, RN, BA (ICSI) (Project Manager)

Financial Disclosures/Other Potential Conflicts of Interest

The Institute for Clinical Systems Improvement (ICSI) has long had a policy of transparency in declaring potential conflicting and competing interests of all individuals who participate in the development, revision and approval of ICSI guidelines and protocols.

In 2010, the ICSI Conflict of Interest Review Committee was established by the Board of Directors to review all disclosures and make recommendations to the board when steps should be taken to mitigate potential conflicts of interest, including recommendations regarding removal of work group members. This committee has adopted the Institute of Medicine Conflict of Interest standards as outlined in the report Clinical Practice Guidelines We Can Trust (2011).

Where there are work group members with identified potential conflicts, these are disclosed and discussed at the initial work group meeting. These members are expected to recuse themselves from related discussions or authorship of related recommendations, as directed by the Conflict of Interest committee or requested by the work group.

The complete ICSI policy regarding Conflicts of Interest is available at the ICSI Web site External Web Site Policy.

Disclosure of Potential Conflicts of Interest

Sharon Allen, MD (Work Group Member)
Family Medicine, University of Minnesota Physicians
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: Programmatic support from the National Institute on Drug Abuse (NIDA) – Nicotine dependence in pregnancy and post partum. Money to institution, none to individual member.
Financial/Non-financial Conflicts of Interest: None

Luke Benedict, MD (Work Group Member)
Endocrinology, Allina Medical Clinics
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-financial Conflicts of Interest: Paid participant of a study evaluating efficacy of a blood glucose meter in identifying trends in blood sugars

Renee B. Compo, RN, CNP (Work Group Member)
Women's Health, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-financial Conflicts of Interest: None

Robert Florence, MD, FACP, CCD (Work Group Leader)
Internal Medicine, Allina Medical Clinics
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-financial Conflicts of Interest: None

Amanda Jensen, RTR (Work Group Member)
HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-financial Conflicts of Interest: None

Dionysia Kalogeropoulou, MD (Work Group Member)
HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: ICSI Diabetes Guideline
Research Grants: None
Financial/Non-financial Conflicts of Interest: None

Ann Kearns, MD, PhD (Work Group Member)
Endocrinology, Mayo Clinic
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-financial Conflicts of Interest: None

Sarah Larsen (Work Group Member)
Allina Medical Clinics
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-financial Conflicts of Interest: None

Kathryn O'Day, MD (Work Group Member)
Endocrinology, Allina Medical Clinics
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: Fairview Physicians Associates – None
Financial/Non-financial Conflicts of Interest: None

Amber Peltier, PharmD (Work Group Member)
Pharmacy, HealthPartners Medical Group
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: Thrasher Research Foundation – None
Financial/Non-financial Conflicts of Interest: None

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2013 Jul

Measure Maintenance

Scientific documents are revised every 12 to 24 months as indicated by changes in clinical practice and literature.

Date of Next Anticipated Revision

The next scheduled revision will occur within 24 months.

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2016.

Source(s)

Florence R, Allen S, Benedict L, Compo R, Jensen A, Kalogeropoulou D, Kearns A, Larson S, Mallen E, O'Day K, Peltier A, Webb B. Diagnosis and treatment of osteoporosis. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Jul. 87 p. [210 references]

Measure Availability

Source available for purchase from the Institute for Clinical Systems Improvement (ICSI) Web site External Web Site Policy. Also available to ICSI members for free at the ICSI Web site External Web Site Policy and to Minnesota health care organizations free by request at the ICSI Web site External Web Site Policy.

For more information, contact ICSI at 8009 34th Avenue South, Suite 1200, Bloomington, MN 55425; Phone: 952-814-7060; Fax: 952-858-9675; Web site: www.icsi.org External Web Site Policy; E-mail: icsi.info@icsi.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on April 9, 2014.

The information was reaffirmed by the measure developer on January 13, 2016.

Copyright Statement

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

If the abstracted ICSI Measures are downloaded by an organization, copies may be distributed to the organization's employees but may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved by the Institute for Clinical Systems Improvement, Inc. The Institute for Clinical Systems Improvement, Inc. assumes no liability for any adaptations or revisions or modifications made to the abstracts of the ICSI Measures.

NQMC Disclaimer

The National Quality Measures Clearinghouse™ (NQMC) does not develop, produce, approve, or endorse the measures represented on this site.

All measures summarized by NQMC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public and private organizations, other government agencies, health care organizations or plans, individuals, and similar entities.

Measures represented on the NQMC Web site are submitted by measure developers, and are screened solely to determine that they meet the NQMC Inclusion Criteria.

NQMC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or its reliability and/or validity of the quality measures and related materials represented on this site. Moreover, the views and opinions of developers or authors of measures represented on this site do not necessarily state or reflect those of NQMC, AHRQ, or its contractor, ECRI Institute, and inclusion or hosting of measures in NQMC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding measure content are directed to contact the measure developer.

About NQMC Measure Summaries

NQMC provides structured summaries containing information about measures and their development.

Measure Summary FAQs


Measure Summaries

New This Week

View more and sign up for our Newsletter

Get Adobe Reader