Quality Measures and Quality Improvement Initiatives in Osteoporosis—an Update

  • S. French
  • S. Choden
  • Gabriela SchmajukEmail author
Quality of Care in Osteoporosis (S Silverman and J Curtis, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Quality of Care in Osteoporosis


Purpose of Review

The aims of this review are to summarize current performance for osteoporosis quality measures used by Centers for Medicare and Medicaid (CMS) for pay-for-performance programs and to describe recent quality improvement strategies around these measures.

Recent Findings

Healthcare Effectiveness Data and Information (HEDIS) quality measures for the managed care population indicate gradual improvement in osteoporosis screening, osteoporosis identification and treatment following fragility fracture, and documentation of fall risk assessment and plan of care between 2006 and 2016. However, population-based studies suggest achievement for these process measures is lower where reporting is not mandated. Performance gaps remain, particularly for post-fracture care. Elderly patients with increased comorbidity are especially vulnerable to fractures, yet underperformance is documented in this population. Gender and racial disparities also exist. As has been shown for other areas of health care, education alone has a limited role as a quality improvement intervention. Multifactorial and systems-based interventions seem to be most successful in leading to measurable change for osteoporosis care and fall prevention.


Despite increasing recognition of evidence-based quality measures for osteoporosis and incentives to improve upon performance for these measures, persistent gaps in care exist that will require further investigation into sustainable and value-adding quality improvement interventions.


Osteoporosis Falls Quality measure Quality improvement Medicare MACRA/MIPS 


Funding Information

Dr. French is supported by NIAMS T32 AR007304. Dr. Schmajuk is supported by the Russell/Engleman Rheumatology Research Center.

Compliance with Ethical Standards

Conflict of Interest

Sonam Choden and Sarah French declare no conflict of interest. Gabriela Schmajuk reports grants from Russell/Engleman Rheumatology Research Center, grants from American College of Rheumatology, grants from AHRQ, grants from Alpha Foundation, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. 1.Division of Rheumatology, Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.Philip R. Lee Institute for Health Policy Studies, University of CaliforniaSan FranciscoUSA
  3. 3.Rheumatology Section, Medical Service, San Francisco VA HospitalSan FranciscoUSA

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