Table 11-2ACOVE-2 Quality Indicators for the Management of Osteoporosis in Vulnerable Elders

Indicator PurposeProcess Measure
Quality Indicator 1
Prevention
ALL female persons age 75 or older should be counseled at least once regarding intake of dietary calcium and vitamin D and weight-bearing exercise.
Quality Indicator 2
Smoking Cessation
ALL female persons age 75 or older who smoke should be counseled annually about smoking cessation.
Quality Indicator 3
Pharmacologic Preventive Therapy
EVERY female person age 75 or older should be counseled about risk for osteoporosis and the potential need for pharmacologic prevention of osteoporosis at least once.
Quality Indicator 4
Identifying Secondary Osteoporosis
IF a person age 75 or older has a new diagnosis of osteoporosis, THEN during the initial evaluation period an underlying cause of osteoporosis should be sought by checking medication use and current alcohol use.
Quality Indicator 5
Calcium and Vitamin D for Osteoporosis
IF a person age 75 or older has osteoporosis, THEN calcium and vitamin D supplements should be recommended at least once.
Quality Indicator 6
Calcium and Vitamin D With Corticosteroid Use
IF a person age 75 or older is taking corticosteroids for more than 1 month, THEN the patient should be offered calcium and vitamin D.
Quality Indicator 7
Treatment of Osteoporosis
IF a person age 75 or older is newly diagnosed with osteoporosis, THEN the patient should be offered treatment with hormone replacement therapy, SERMs, bisphosphonates, or calcitonin within 3 months of diagnosis.*
*

Note: Estrogen is listed as an option, with the Women’s Health Initiative finding that it is effective for the prevention of hip fractures. Potential increases in risk of cardiovascular disease may make it a less favorable choice.

Source: RAND 2004.

From: 11, Systems-based Approaches to Bone Health

Cover of Bone Health and Osteoporosis
Bone Health and Osteoporosis: A Report of the Surgeon General.
Office of the Surgeon General (US).
Rockville (MD): Office of the Surgeon General (US); 2004.

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