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Osteoporosis : secondary prevention of fragility fractures (OST)

Patients aged 75 years and over with a fragility fracture on or after 1 April 2014 and a diagnosis of osteoporosis.

Bone sparing agent codes - Prescibed after 1st October, i.e. in the preceding 6 months

fo1..% DISODIUM ETIDRONATE
fo4..% ALENDRONIC ACID
fo6..% RISEDRONATE SODIUM
fo8..% IBANDRONIC ACID
fv1..% RALOXIFENE HYDROCHLORIDE
fu3..% TERIPARATIDE
fu5..% STRONTIUM
fu9..% DENOSUMAB
fo7..% ZOLEDRONIC ACID
8BP1. Teriparatide therapy
8B6c. Intravenous bisphosphonate prophylaxis
8B6b. Osteoporosis medication prophylaxis
8BPW. Denosumab therapy
8BPX. Ibandronic acid therapy
8BPZ. Parathyroid hormone therapy
8BPY. Zoledronic acid therapy

Bone sparing agent therapy not indicated - added in the last 12 months

8I615 Bone sparing agent therapy not indicated (v28)

Bone sparing agent contra-indications: persistent

14LT. H/O: bisphosphonate allergy
ZV14K [V]Personal history of bisphosphonate allergy
14LT3 H/O alendronic acid allergy
14LT4 H/O risedronate sodium allergy
14LT1 H/O zoledronic acid monohydrate allergy
14LT2 H/O disodium etidronate allergy
14LT0 H/O ibandronic acid allergy
14La. H/O: raloxifene allergy
14Lb. H/O: teriparatide allergy
14Lc. H/O denosumab allergy
14LW. H/O: strontium ranelate allergy
ZV14H [V]Personal history of strontium ranelate allergy

Bone sparing agent cat1 contra-indications: expiring - added in the last 12 months

8I3e. Bisphosphonates declined
8I6R. Bisphosphonates not indicated
8I7E. Bisphosphonates not tolerated
8I2V. Bisphosphonates contraindicated
8I2V3 Alendronic acid contraindicated
8I3e3 Alendronic acid declined
8I6R3 Alendronic acid not indicated
8I7E3 Alendronic acid not tolerated
8I2V2 Disodium etidronate contraindicated
8I3e2 Disodium etidronate declined
8I6R2 Disodium etidronate not indicated
8I7E2 Disodium etidronate not tolerated
8I7E1 Zoledronic acid monohydrate not tolerated
8I2V0 Ibandronic acid contraindicated
8I2V1 Zoledronic acid monohydrate contraindicated
8I3e0 Ibandronic acid declined
8I3e1 Zoledronic acid monohydrate declined
8I6R0 Ibandronic acid not indicated
8I6R1 Zoledronic acid monohydrate not indicated
8I7E0 Ibandronic acid not tolerated
8I2V4 Risedronate sodium contraindicated
8I3e4 Risedronate sodium declined
8I6R4 Risedronate sodium not indicated
8I7E4 Risedronate sodium not tolerated
8I6p. Raloxifene not indicated
8I7P. Raloxifene not tolerated
8IEH. Raloxifene declined
8I2l. Raloxifene contraindicated
8I6q. Teriparatide not indicated
8I7Q. Teriparatide not tolerated
8IED. Teriparatide declined
8I2m. Teriparatide contraindicated
8I2p. Denosumab contraindicated
8IEW. Denosumab declined
8I612 Denosumab not indicated

8I7S. Denosumab not tolerated

8I3h. Strontium ranelate declined
8I6V. Strontium ranelate not indicated
8I7H. Strontium ranelate not tolerated
8I2Y. Strontium ranelate contraindicated

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Osteoporosis exception reporting codes

9hP.. Exception reporting: osteoporosis quality indicators
9hP0. Excepted from osteoporosis quality indicators: patient unsuitable
9hP1. Excepted from osteoporosis quality indicators: informed dissent

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Osteoporosis 005.1 Rationale

See OST 002.1

NICE and SIGN recommend bone-sparing agents for the secondary prevention of osteoporotic fragility fractures in people confirmed to have osteoporosis. In April 2014 this indicator was amended so only people with a record of a diagnosis of osteoporosis in addition to a record of a fragility fracture are included in the denominator. This indicator does not require that a diagnosis of osteoporosis is confirmed by DXA scan in patients aged 75 or over with a fragility fracture. However, it is recommended clinical practice that this group are considered for a DXA scan. NICE recommends that a diagnosis of osteoporosis may be assumed in women aged 75 or over with a fragility fracture if the responsible clinician considers a DXA scan to be clinically inappropriate or unfeasible157. SIGN recommends that in frail elderly women (aged 80 or over) a DXA scan would be a prerequisite to establish BMD is sufficiently low before starting treatment with bone-sparing agents (biophosphonates), unless the patient has suffered multiple vertebral fractures.

NICE (2008) Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (amended January 2010 and January 2011). NICE technology appraisal guidance 161. Available from www.nice.org.uk/guidance/TA161

Osteoporosis 005.2 Reporting and verification

See indicator wording for requirement criteria.

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Prepared By Jean Keenan