Osteoporosis Management in Women Who Had a Fracture

Measure Specification

Osteoporosis is the most common metabolic bone disease and is characterized by low bone mineral density and structural deterioration of bone tissue, causing bone fragility and increasing the risk of fractures. It is estimated that by 2020, approximately 11.9 million people age 50 and older will have osteoporosis. Osteoporosis affects about 25% of women age 65 and older.

The cost of osteoporosis-related fractures to patients, families and the health care system is $19 billion annually. Experts predict that by 2025 osteoporosis will be responsible for 3 million fractures annually, resulting in $25.3 billion in costs. The aging U.S. population is likely to increase the financial cost of osteoporosis care. Each year, there are approximately 1.

5 million osteoporotic fractures in the United States. Fragility fractures (fractures from falls from a standing position) are considered one of the most serious warning signs of osteoporosis or low bone density. Individuals who experience a fragility fracture have a 1.5-to 9.5-fold increased risk of further fracture. Osteoporosis related fractures can occur in the hip, vertebrae, shin, and other bones.

Hip fractures have been linked to lower quality of life, increased mortality and a dependent living status. A review of the Health and Retirement Study indicated that 27% of adults age 50 and older died 1 year after a hip fracture. Pharmacologic treatment can reduce the risk of subsequent fractures by 30%–50%. Unfortunately, testing and treatment for low bone mass after fracture has been shown to be as low as 20%.

This and other research suggests a large opportunity for organizations to improve how well they manage women at an increased risk for fracture. The organization can improve its performance on this measure by both educating practitioners on follow-up care after fracture and by tracking administrative data for the occurrence of fracture and following up to ensure that appropriate care was provided.

The U.S. Preventive Services Task Force (USPSTF) recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older (Grade B) (USPSTF 2018). This recommendation applies to older adults without a history of low-trauma fractures and without conditions that may cause secondary osteoporosis (such as metabolic bone disease or untreated hyperthyroidism) and patients without conditions that may increase their risk of falls.

This recommendation does not apply to persons who take long-term medications that may cause secondary osteoporosis (e.g., glucocorticoids, aromatase inhibitors, or gonadotropin-releasing hormone agonists). The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool (Grade B) (USPSTF 2018).

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this episode measure is submitted once for each occurrence of a particular illness or condition during the performance period. Each occurrence of a fracture is identified by either an ICD-10-CM diagnosis code for fracture and a CPT service code OR an ICD-10-CM diagnosis code for a fracture and a CPT procedure code for surgical treatment of fractures.