Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapy

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 use or accuracy of third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2020. American Medical Association. LOINC(R) copyright 2004-2020 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2020. International Health Terminology Standards Development Organisation. ICD-10 copyright 2020 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].

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Androgen suppression as a treatment for prostate cancer can cause osteoporosis (Qaseem, 2008). Men undergoing prolonged androgen deprivation therapy (ADT) incur bone loss at a rate higher than menopausal women (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 including a baseline assessment of bone density with a DEXA scan and daily calcium and Vitamin D supplementation (Watts, 2012). The DEXA scan is the gold standard for bone density screening. Men 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.

A higher score indicates better quality

Reference Type: CITATION

Reference Text: 'Cosman, F., deBeur, S., LeBoff, M., et al. (2014,June). Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis International, 25(10), 2359–2381. Retrieved from
http://link.springer.com/article/10.1007/s00198-014-2794-2'

Reference Type: CITATION

Reference Text: 'Finkelstein, J., & Yu, E. (2017). Clinical manifestations, diagnosis, and evaluation of osteoporosis in men. Retrieved from
https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-evaluation-of-osteoporosis-in-men/print?source=see_link'

Reference Type: CITATION

Reference Text: 'Guise, T., Oefelein, M., Eastham, J., et al. (2007). Estrogenic side effects of androgen deprivation therapy. Reviews in Urology, 9(4), 163-180. Retrieved from
https://www.researchgate.net/profile/Celestia_Higano/publication/5619579_Estrogenic_side_effects_of_androgen_deprivation_therapy/links/0c960526434483fdfd000000.pdf'

Reference Type: CITATION

Reference Text: 'Qaseem, A., Snow, V., Shekelle, P., et al. (2008). Annals of Internal Medicine. Screening for osteoporosis in men: A clinical practice guideline from the American College of Physicians, 2008. Annals of Internal Medicine, 148(9), 680-684. Retrieved from
http://annals.org/aim/article/740825/screening-osteoporosis-men-clinical-practice-guideline-from-american-college-physicians'

Reference Type: CITATION

Reference Text: 'Ward, R., Roberts, C., Bencardino, J., et al. (2016). American College of Radiology: ACR Appropriateness Criteria (R)—Osteoporosis and bone mineral density. Retrieved from
https://www.jacr.org/article/S1546-1440(17)30198-9/pdf'

Reference Type: CITATION

Reference Text: 'Watts, N., Adler, R., Bilezikian, J., et al. (2012, June). Osteoporosis in men: An Endocrine Society clinical practice guideline, Journal of Clinical Endocrinology & Metabolism, 97(6), 1802–1822. Retrieved from
https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2011-3045'

Data Criteria Value Set 2.16.840.1.113762.1.4.1151.38 DEXA, Dual Energy Xray Absorptiometry, Bone Density for Urology Care contains 2 LOINC codes identifying the axial and appendicular skeleton and will meet the measure intent.

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 twelve month period (regime/therapy) is the correct code.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Male 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

Equals Initial Population

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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

Not Applicable

Patient refused recommendation for a bone density evaluation after the start of ADT therapy

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

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