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 any Current Procedural Terminology (CPT [R]) or other coding contained in the specifications.

CPT (R) contained in the Measure specifications is copyright 2007- 2016 American Medical Association. 

LOINC (R) copyright 2004-2016 [2.56] Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2016 [2015-09] International Health Terminology Standards Development Organization. All Rights Reserved. ICD-10 is copyright 2016 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].

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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

Cosman,F; deBeur,S; LeBoff,M; Lewiecki,E; Tanner,B; Randall,S; Lindsay,R. Osteoporosis International. Clinician's Guide to Prevention and Treatment of Osteoporosis, June, 2014.
http://link.springer.com/article/10.1007/s00198-014-2794-2

Finkelstein,J; Yu,E. UpToDate. Clinical manifestations, diagnosis, and evaluation of osteoporosis in men, 2017.
https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-evaluation-of-osteoporosis-in-men/print?source=see_link 

Guise,T; Oefelein,M; Eastham,J; Cookson,M; Higano,C; Smith,M. Reviews in Urology. Estrogenic Side Effects of Androgen Deprivation Therapy, 2007.
https://www.researchgate.net/profile/Celestia_Higano/publication/5619579_Estrogenic_side_effects_of_androgen_deprivation_therapy/links/0c960526434483fdfd000000.pdf

Qaseem,A; Snow,V; Shekelle,P; et al. Annals of Internal Medicine. Screening for Osteoporosis in Men: A Clinical Practice Guideline from the American College of Physicians, 2008.
http://annals.org/aim/article/740825/screening-osteoporosis-men-clinical-practice-guideline-from-american-college-physicians

Ward,R; Roberts,C; Bencardino,J; Baccei,S; Cassidy,R; Chang,E; Fox,M; Greenspan,B; Gyftopoulos,S; Hochman,M; Mintz,D; Newman,J; Reitman,C; Rosenberg,S; Shah,N; Small,K; Weisman,B. American College of Radiology. ACR Appropriateness Criteria (R) osteoporosis and bone mineral density, 2016.
https://www.guideline.gov/summaries/summary/50461/acr-appropriateness-criteria--osteoporosis-and-bone-mineral-density

Watts,N; Adler,R; Bilezikian,J; Drake,M; Eastell,R; Orwoll,E; Finkelstein,J. Journal of Clinical Endocrinology & Metabolism. Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline, June, 2012.
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.

In order to capture the practitioner's intent of androgen deprivation therapy (ADT) for a period of 12 months or greater, the custom HCPCS code of J1950,cont was added to the $ADT variable as Procedure, Order. Each EHR can define this custom code as intended therapy for 12 months or greater with the practitioner indicating this code at the start of the intended therapy.

TBD

Male patients with a diagnosis of prostate cancer and an order for or who are actively undergoing ADT for a period greater than or equal to 12 months with an office visit 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

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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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