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## Complete Summary

#### TITLE

Osteoporosis: percentage of patients aged 50 years and older with a
diagnosis of osteoporosis who were prescribed pharmacologic therapy
within 12 months.

#### SOURCE(S)

American Academy of Family Physicians, American Academy of Orthopaedic
Surgeons, American Association of Clinical Endocrinologists, American
College of Rheumatology, Endocrine Society, Physician Consortium for
Performance Improvement®, National Committee for Quality Assurance.
Osteoporosis physician performance measurement set. Chicago (IL):
American Medical Association, National Committee for Quality Assurance;
2006 Oct. 15 p. \[7 references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients aged 50 years
and older with a diagnosis of osteoporosis who were prescribed
pharmacologic therapy within 12 months.

#### RATIONALE

Pharmacologic therapy is an evidence-based recommendation for the
treatment of osteoporosis.\*

\*The following clinical recommendation statements are quoted
[verbatim]{.underline} from the referenced clinical guidelines and
support the rationale:

Agents approved by the Food and Drug Administration (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 some of
the bisphosphonates have been shown to reduce the risk of hip fractures
in prospective controlled trials (level 1). (American Association of
Clinical Endocrinologists \[AACE\])

US FDA 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). (National Osteoporosis Foundation
\[NOF\])

#### PRIMARY CLINICAL COMPONENT

Osteoporosis; pharmacologic therapy (bisphosphonates \[alendronate,
ibandronate, and risedronate\], calcitonin, estrogens \[estrogens and/or
hormone therapy\], parathyroid hormone \[PTH (1-34), teriparatide\], and
selective estrogen receptor modules or SERMs \[raloxifene\])

#### DENOMINATOR DESCRIPTION

All patients aged 50 years and older with the diagnosis of osteoporosis
(see the related \"Denominator Inclusions/Exclusions\" field in the
Complete Summary)

#### NUMERATOR DESCRIPTION

Patients who were prescribed pharmacologic therapy within 12 months (see
the related \"Numerator Inclusions/Exclusions\" field in the Complete
Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

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

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Physician\'s guide to prevention and treatment of
    osteoporosis.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3862)

-   [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.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=4157)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance\
Variation in quality for the performance measured

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Feldstein A, Elmer PJ, Orwoll E, Herson M, Hillier T. Bone mineral
density measurement and treatment for osteoporosis in older individuals
with fractures: a gap in evidence-based practice guideline
implementation. Arch Intern Med2003 Oct 13;163(18):2165-72. \[46
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14557214)

Mudano AS, Casebeer L, Patino F, Allison JJ, Weissman NW, Kiefe CI,
Person S, Gilbert D, Saag KG. Racial disparities in osteoporosis
prevention in a managed care population. South Med J2003
May;96(5):445-51.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12911182)

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.

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement\
National reporting

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Age greater than or equal to 50 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness\
Staying Healthy

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All patients aged 50 years and older with the diagnosis of osteoporosis

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients aged 50 years and older with the diagnosis of osteoporosis

**Exclusions**

-   Documentation of medical reason(s) for not prescribing pharmacologic
    therapy

-   Documentation of patient reason(s) for not prescribing pharmacologic
    therapy

-   Documentation of system reason(s) for not prescribing pharmacologic
    therapy

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients who were prescribed pharmacologic therapy\* within 12 months

\***Note**: U.S. Food and Drug Administration approved pharmacologic
options for osteoporosis prevention and/or treatment of postmenopausal
osteoporosis include, in alphabetical order: bisphosphonates
(alendronate, ibandronate, and risedronate), calcitonin, estrogens
(estrogens and/or hormone therapy), parathyroid hormone \[PTH (1-34),
teriparatide\], and selective estrogen receptor modules or SERMs
(raloxifene).

**Exclusions**\
None

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Fixed time period

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Measure #4: pharmacologic therapy.

#### MEASURE COLLECTION

[The Physician Consortium for Performance Improvement® Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1912&doc=178)

#### MEASURE SET NAME

[Osteoporosis Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1912&doc=10264)

#### SUBMITTER

American Medical Association on behalf of the AAFP, AAOS, AACE, American
College of Rheumatology, The Endocrine Society, Physician Consortium for
Performance Improvement®, and the National Committee for Quality
Assurance

#### DEVELOPER

American Academy of Family Physicians\
American Academy of Orthopaedic Surgeons\
American Association of Clinical Endocrinologists\
American College of Rheumatology\
National Committee for Quality Assurance\
Physician Consortium for Performance Improvement®\
The Endocrine Society

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Steven Petak, MD, JD, FACE (*Co-Chair*); Kenneth Saag, MD, MSc
(*Co-Chair*); Robert Adler, MD; H. Chris Alexander, III, MD, FACP;
Donald Bachman, MD, FACR; Joel Brill, MD; Jan Busby-Whitehead, MD;
Thomas Dent, MD; Nancy Dolan, MD; Leonie Gordon, MB, ChB; Tomas
Griebling, MD; Richard Hellman, MD, FACP, FACE; Marc C. Hochberg, MD,
MPH; C. Conrad Johnston, Jr., MD; Joseph Lane, MD; Leon Lenchik, MD;
Bonnie McCafferty, MD, MSPH; Michael Maricic, MD; Michael L. O\'Dell,
MD, MSHA, FAAFP; Sam J.W. Romeo, MD, MBA; Frank Salvi, MD, MS; Joseph
Shaker, MD; Madhavi Vemireddy, MD; David Wong, MD, MSc, FRS(C)

Bruce Bagley, MD, American Academy of Family Physicians; Janet Leiker,
RN, MPH, CPHQ, American Academy of Family Physicians

Bob Haralson, MD, MBA, American Academy of Orthopaedic Surgeons; Jill
Hughes, American Academy of Orthopaedic Surgeons

Tammy L. Chaney, American Association of Clinical Endocrinologists

Amy Miller, American College of Rheumatology

Janet Kreizman, The Endocrine Society

Rebecca A. Kresowik, Facilitators; Timothy F. Kresowik, MD, Facilitator

Heidi Bossley, MSN, MBA, American Medical Association; Karen S. Kmetik,
PhD, American Medical Association

Roberta Biegel, National Osteoporosis Foundation

Sarah Sampsel, MPH, National Committee for Quality Assurance

Ann Watts, RN, Joint Commission on Accreditation of Healthcare
Organizations

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Conflicts, if any, are disclosed in accordance with the Physician
Consortium for Performance Improvement® conflict of interest policy.

#### ENDORSER

National Quality Forum

#### INCLUDED IN

Ambulatory Care Quality Alliance\
Physician Quality Reporting Initiative

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2006 Oct

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

American Academy of Family Physicians, American Academy of Orthopaedic
Surgeons, American Association of Clinical Endocrinologists, American
College of Rheumatology, Endocrine Society, Physician Consortium for
Performance Improvement®, National Committee for Quality Assurance.
Osteoporosis physician performance measurement set. Chicago (IL):
American Medical Association, National Committee for Quality Assurance;
2006 Oct. 15 p. \[7 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Measure #4: Pharmacologic Therapy,\" is
published in the \"Osteoporosis Physician Performance Measurement Set.\"
This document and technical specifications are available in Portable
Document Format (PDF) from the American Medical Association
(AMA)-convened Physician Consortium for Performance Improvement® Web
site:
[www.physicianconsortium.org](http://www.physicianconsortium.org/).

For further information, please contact AMA staff by e-mail at
<cqi@ama-assn.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on October 12, 2007.
The information was verified by the measure developer on November 21,
2007.

#### COPYRIGHT STATEMENT

© Measures including specifications

© 2005-6 American Medical Association and National Committee for Quality
Assurance

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/10/2008