Osteoporosis, often referred to as the “silent disease,” is a common yet underdiagnosed condition responsible for an estimated two million broke bones per year. Osteoporosis-related fractures cost patients, their families, and healthcare systems over $19 billion annually. For patients, these fractures can result in chronic pain, loss of independence, decreased quality of life, and increased mortality.
The most common fractures associated with osteoporosis occur in the hip, spine, and wrist. Hip fractures are especially concerning due to their associated mortality rates. Understanding the risk factors associated with osteoporosis is critical for identifying and targeting high-risk patients for intervention. Key risk factors include:
- Age: the risk of osteoporosis increases with age, especially in postmenopausal women.
- Gender: women are more prone to osteoporosis due to hormonal changes during menopause.
- Family History: a history of osteoporosis increases risk.
- Low Body Weight: individuals with lower body weight have reduced bone density and are more susceptible to fractures.
- Hormonal Imbalances: hormonal disorders can contribute to bone loss.
- Medication: long-term use of certain medications can weaken bones.
- Lifestyle Factors: smoking, excessive alcohol consumption, and a sedentary lifestyle can increase the risk of osteoporosis.
Screening using a Bone Mineral Density (BMD) test allows providers to catch osteoporosis early and prevent fractures. To improve Part C Medicare Star Ratings, specifically the HEDIS Osteoporosis Management in Women (OMW) quality measure, follow these best practices to close care gaps related to osteoporosis:
The quality measure, Osteoporosis Management in Women Who Had a Fracture (OMW), is defined as women aged 67-85 who suffered a fracture and had a bone mineral density test or prescription for treatment of a drug to treat osteoporosis in the 6 months after the fracture.
To Close this Quality Gap:
- BMD test must take place within 6 months of a fracture
- Provide patients with a BMD prescription and where to call for an appointment
- Urge patients to alert you if they have a fracture to allow for timely intervention
- If a fracture resulted in an inpatient stay, a BMD test or long-acting osteoporosis medication administered during the inpatient stay will close the care gap
- Documentation that medications aren’t tolerated is not an exclusion for this quality measure
- Osteoporosis medication must be filled using Part D plan to be counted for measure compliance
- Women at risk should receive a BMD test every 2 years (includes those with history of falls or increased risk for falls, being monitored while on FDA-approved osteoporosis drug therapy regimen, a diagnosis of primary hyperparathyroidism, estrogen deficiency, or on long-term steroid therapy)
- Discuss fall prevention
Tips and Tricks:
- 5 STAR performance for this measure is 71% or higher
- This measure tends to have a lower denominator compared to other quality measures
- The post-fracture treatment period to close this care opportunity is only 6 months
- The index episode start date (IESD) is the date you begin counting for the appropriate osteoporosis testing or treatment. This might not be the same as the fracture date.
- Does not include fractures to fingers, toes, face, or skull
- Verify codes for fractures are used appropriately
- BMD testing codes are accepted as supplemental data to reduce the need for chart reviews
- Patients are excluded if they:
- Had a BMD 24 months prior to the fracture
- Had a claim/encounter for osteoporosis medication therapy during the 12 months prior to the fracture
- Were dispensed or had an active prescription to treat osteoporosis during the 12 months prior to the fracture
- Bone density screening is covered by most insurance plans
Osteoporosis prevention and management is vital to the health of beneficiaries and an important part of quality programs STAR Ratings. With early intervention, screening, a full assessment for positive fall screening, and a comprehensive approach to management, healthcare professionals can help reduce the burden of osteoporosis-related fractures.