Quality Indicators for the Care of Osteoporosis in Vulnerable Elders

Osteoporosis is a systemic skeletal disease characterized by the loss of bone mass and disruption of the normal bone architecture that results in greater fracture risk. Osteoporosis is a common condition occurring in an estimated 25 million people in the United States and is the underlying cause in more than 1.5 million fractures each year. It affects elderly people of all races and ethnicities. In 1995, osteoporotic fractures cost an estimated $13.8 billion in the United States. Of individuals with osteoporotic hip fractures, 20% to 50% are unable to return to independent living and 12% to 20% die within 1 year. A variety of strategies to prevent fractures have been shown to be useful but depend on the recognition of the risks of developing bone loss and diagnosing osteoporosis. Bone mineral density (BMD) is the best available tool for assessing risk of osteoporotic fracture, but other factors, in particular, a history of a previous fragility fracture, are useful. Use of preventive interventions could reduce morbidity and mortality in vulnerable elders (VEs). METHODS. A total of 590 articles were considered in this review: 21 identified through a Web search, 230 through reference mining, and 315 through the Assessing Care of Vulnerable Elders (ACOVE)-3 literature searches. Twenty-four additional articles were included after peer review. RESULTS: Of the 19 potential quality indicators (QIs), 13 were judged valid by the expert panel process; six indicators were rejected. The literature summaries that support each of the indicators judged to be valid in the expert panel process are described.