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Osteoporosis is a systemic skeletal disease characterized by low bone mass, microarchitectural deterioration of bone tissue, and a consequent increase in bone fragility and susceptibility to fracture. Approximately 10 million people in the United States, 80% of whom are women, have osteoporosis, and another 18 million (83% women) have low bone mass. Osteoporosis is a major cause of morbidity and death in older persons. The clinical complications of osteoporosis include fractures, most commonly vertebral, hip, and forearm; disability; deformity; and chronic pain. For women who are 50 years of age, the estimated lifetime risk for osteoporotic fracture is 54%. For white men who are 50 years of age, the lifetime risk for hip fracture is an estimated 5% to 6%. Studies suggest that the prevalence of vertebral fractures is similar for men and women. Approximately 4% of patients older than 50 years of age who experience a hip fracture will die while in the hospital, and 24% will die within 1 year of experiencing hip fracture. In the United States in 1995, osteoporotic fractures cost an estimated $13.8 billion. Methods: The methods for developing the ACOVE quality indicators for the management of osteoporosis, including the literature review and expert panel consideration, are detailed elsewhere in this supplement. A structured literature review found 2960 titles on osteoporosis, from which abstracts and articles were identified that were relevant to this report. Based on the literature and the authors' expertise, 24 potential quality indicators were proposed. Results: Of the 24 potential quality indicators, 9 were judged to be valid by the expert panel process, 3 additional indicators were accepted and merged into the indicators presented in this paper, and 12 were not accepted. We summarize the literature supporting each of the indicators judged to be valid by the expert panel process.

Originally published in: Annals of Internal Medicine, v.135, no. 8, pt. 2, October 16, 2001, pp. 722-730.

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