Prevalence (2017-18): 0.2%
£/patient on the register (est.): £30.61
Osteoporosis has been part of the QOF for six years, although it is now purely a register of patients.
This is essentially two registers stuck together. There are different criteria for patients for patients older than 75 and those between 50 and 74.
Patients 50-74 years old
Patients should have had a fragility fracture coded after April 2012. This is not automatic: ultimately it is a clinical decision whether any fracture is due to fragility and it will need to be specifically coded.
It is the age of the patient at the end of the QOF year that matters (at least 50), not the age when they had their fracture. However, to be included they must have had their fracture since April 2012.
They also need to have a DEXA scan result. The DEXA scan result should be osteoporotic or, alternatively, have a T value (at either hip, femoral neck or lumbar spine) of –2.5 or lower.
Finally they should have a diagnostic code for osteoporosis – the DEXA code is not enough. Most of the valid codes mention osteoporosis and a cause, or osteoporosis with a fracture.
With these three codes the patient is logged on the register and eligible for treatment.
Patients 75 and older at the end of the QOF year
Things are a little simpler in older patients. The qualifying date is later – they should have had a fragility fracture after April 2014 and again must be specifically coded as a fragility fracture. A proportion of patients will have automatically moved on from the previous part of the register.
While a DEXA scan may be appropriate, there is no requirement for this to happen before they appear on the register. There does, however, need to be a diagnostic code for osteoporosis.
There are several codes to enter and most of the activity occurs in secondary care.
This is easy to get wrong. Having an effective procedure can ensure that patients appear on the register, as follows:
The indicators for this area requiring treatment with bone sparing agents have been removed. There were concerns about over-treatment and the small numbers of patients involved.
Dr Gavin Jamie is a GP in Swindon and runs the QOF database website
Indicator 1: The contractor establishes and maintains a register of patients:
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