Bone Density Evaluation for Patients with Prostate Cancer and Receiving Androgen Deprivation Therapy

Percentage of patients determined as having prostate cancer who are currently starting or undergoing androgen deprivation therapy (ADT), for an anticipated period of 12 months or greater and who receive an initial bone density evaluation. The bone density evaluation must be prior to the start of ADT or within 3 months of the start of ADT.

Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Oregon Urology Institute (OUI) and Large Urology Group Practice Association (LUGPA) disclaim all liability for the use or accuracy of third-party codes contained in the specifications.
CPT (R) only Copyright 2025 American Medical Association. All rights Reserved. No fee schedules, basic unit, relative values or related listings are included in CPT (R). AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained herein.  
This material contains content from LOINC (http://loinc.org). LOINC is copyright (C) Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at http://loinc.org/license. LOINC (R) is a registered United States trademark of Regenstrief Institute, Inc. 
This material includes SNOMED Clinical Terms (R) (SNOMED CT [R]) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO). All rights reserved. SNOMED CT (R), was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO. 
ICD-10 is copyright 2025 World Health Organization. All Rights Reserved. 

The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.
THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

None

None

None

Androgen suppression as a treatment for prostate cancer can cause osteoporosis (Qaseem, 2008). Patients with prostate cancer undergoing prolonged androgen deprivation therapy (ADT) incur bone loss at a rate higher than menopausal patients (Guise, 2007). In preserving bone health, the goal is to prevent or treat osteopenia/osteoporosis for the patient on ADT and to prevent or delay skeletal-related events. The National Osteoporosis Foundation recommendations include a baseline assessment of bone density with a dual-energy X-ray absorptiometry (DEXA) scan and daily calcium and Vitamin D supplementation (Watts, 2012). The DEXA scan is the gold standard for bone density screening. Patients at risk for adverse bone consequences from chronic ADT do not always receive care according to evidence-based guidelines. These findings call for improved processes that standardize evidence-based practice, including baseline and follow-up bone density assessment (Watts, 2012).

Bone density screening should be performed at the start of Androgen Deprivation Therapy (ADT) for prostate cancer. It should also be performed every 2 years for the patient with continued ADT or for patients with known osteoporosis. Current insurance practice is to possibly cover the cost of bone density screening if osteoporosis is known or if there is a high-risk drug. Some patients choose to delay bone density screening until after ADT is started and they therefore have insurance authorization due to the administration of a high-risk drug.

Higher score indicates better quality

Reference Type: Citation

Reference Text: 
Cosman, F., de Beur, S. J., LeBoff, M. S., Lewiecki, E. M., Tanner, B., Randall, S., & Lindsay, R. (2014). Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis International, 25(10), 2359–2381. https://doi.org/10.1007/s00198-014-2794-2

Reference Type: Citation

Reference Text: 
Finkelstein, J. S., & Yu, E. W. (2017). Clinical manifestations, diagnosis, and evaluation of osteoporosis in men (C. J. Rosen & K. Rubinow, Eds.). UpToDate. https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-evaluation-of-osteoporosis-in-men

Reference Type: Citation

Reference Text: 
Guise, T. A., Oefelein, M. G., Eastham, J. A., Cookson, M. S., Higano, C. S., & Smith, M. R. (2007). Estrogenic side effects of androgen deprivation therapy. Reviews in urology, 9(4), 163–180.

Reference Type: Citation

Reference Text: 
Qaseem, A., Snow, V., Shekelle, P., Hopkins, R., Jr, Forciea, M. A., Owens, D. K., & Clinical Efficacy Assessment Subcommittee of the American College of Physicians (2008). Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 148(9), 680–684. https://doi.org/10.7326/0003-4819-148-9-200805060-00008

Reference Type: Citation

Reference Text: 
Ward, R. J., Roberts, C. C., Bencardino, J. T., Arnold, E., Baccei, S. J., Cassidy, R. C., Chang, E. Y., Fox, M. G., Greenspan, B. S., Gyftopoulos, S., Hochman, M. G., Mintz, D. N., Newman, J. S., Reitman, C., Rosenberg, Z. S., Shah, N. A., Small, K. M., & Weissman, B. N. (2017). ACR Appropriateness Criteria (R) osteoporosis and bone mineral density. Journal of the American College of Radiology, 14(5), S189–S202. https://doi.org/10.1016/j.jacr.2017.02.018

Reference Type: Citation

Reference Text: 
Watts, N. B., Adler, R. A., Bilezikian, J. P., Drake, M. T., Eastell, R., Orwoll, E. S., & Finkelstein, J. S. (2012). Osteoporosis in men: An endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 97(6), 1802–1822. https://doi.org/10.1210/jc.2011-3045

DEXA: Dual Energy X-ray Absorptiometry - A scan that measures the bone of the spine, hip, or total body and measures bone mineral density. It is considered one of the most accurate measurements.
PDXA: Peripheral Dual Energy X-ray Absorptiometry - Bone mineral density measurement of the wrist, heel, or finger.
First Androgen Deprivation Therapy: The first Androgen Deprivation Therapy (ADT) is measured as the first order or administration of ADT for an anticipated period of 12 months or greater to a patient with prostate cancer.

In order to capture the practitioner's intent of androgen deprivation therapy (ADT) for a period of 12 months or greater, SNOMEDCT 456381000124102 which is Injection of leuprolide acetate for the twelve-month period (regime/therapy) is the correct code.
This eCQM is a patient-based measure.
This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Patients with a qualifying encounter in the measurement period AND with a diagnosis of prostate cancer AND with an order for ADT or an active medication of ADT with an intent for treatment greater than or equal to 12 months during the measurement period AND order for ADT in 3 months before to 9 months after the start of the measurement period

Equals Initial Population

None

Patients with a bone density evaluation within the two years prior to the start of or less than three months after the start of ADT treatment

None

Patient refused the bone density evaluation at the time ordered or did not have it performed within 3 months after the start of ADT

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

None