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:
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 (Medicare 2025 Part C & D Star Ratings Technical Notes).
- 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. The IESD may or may not be the same as the fracture date.
- This measure does not include fractures to the finger, toe, face or skull.
- Verify codes for fractures are used appropriately, to prevent women from being included in this measure incorrectly.
- Bone mineral density testing codes can be accepted as supplemental data to reduce the need for some chart reviews.
- Patients who had a BMD 24 months prior to the fracture are excluded.
- Patients who had a claim/encounter for osteoporosis medication therapy during the 12 months prior to the fracture are excluded.
- Patients who were dispensed or had an active prescription to treat osteoporosis during the 12 months prior to the fracture are excluded.
- Bone density screening is a covered benefit for most insurance plans.
- Refer to the full measure specifications for additional details.
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.
