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Add DXA scans to QOF, say experts

Referral for DXA scanning is one of a set of new osteoporosis indicators that should be added to the quality framework, an NHS-commissioned advisory group has said.

The recommendations (see box) have been submitted to the expert review panel for the QOF.

The report was commissioned by the NHS Information Centre and written by GP academics, the primary care forum of the National Osteoporosis Society and the Royal College of Physicians.

Primary care was singled out for having extremely low rates of referral of patients with a previous fragility fracture.

Practices were also criticised for not recording assessments or referrals on patient records.

Former GP Dr Jonathan Bayly, associate lecturer at the University of Derby who co-wrote the report, said both issues could be solved by encouraging GPs, through the QOF, to take a ‘strategic focus' on osteoporosis.

He told Pulse: ‘The report tells the negotiators what would happen if every GP in the country pressed the button tomorrow and identified every patient at risk of osteoporosis or falls on every register.

‘Getting the care of people at high risk of osteoporosis and falls right would transform the management of these patients.'

Dr Eamonn Brankin, a GP in Coatbridge in Lanarkshire, said while the other indicators were more straightforward, an indicator for DXA scanning was ‘a huge amount of work'.

‘A lot will depend on how well summarised people's notes are and there are huge numbers of people out there who have had fragility fractures who have not been referred for scanning.'

Dr Brankin, whose previous research has shown too few patients are referred for DXA scans, added: ‘DXA scanners are not available everywhere, neither are fracture liaison services.

‘It would be a huge undertaking for PCTs and trusts to offer these services.'

Proposed osteoporosis indicators Proposed osteoporosis indicators

Glucocorticoids
• % of patients aged 65+ with at least two prescriptions for systemic glucocorticoids in past six months
• % of patients aged 65+ with at least one prescription for systemic glucocorticoids in past six months

Fragility fractures
• % of women aged 75+ with a history of fragility fracture prescribed a bone-sparing agent
• % of women aged 65-74 with a history of fragility fracture referred for bone densitometry
• % of women aged 65-74 with a history of fragility fracture prescribed a bone sparing agent

Residential/nursing homes
• % of patients aged 75+ in care home on combined calcium-vitamin D

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