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Gold, incentives and meh

New quality indicators for osteoporosis

As the lead author on the QOF submission for osteoporosis and one of the joint authors of the recently published Information Centre report on standards in the management of osteoporosis and falls in primary care, I wondered if I could clarify one or two points in your recent report ‘Add DXA scans to QOF, say experts', (News, 20 September).

The authors made a number of recommendations but the incorporation of an indicator for DXA scans in the QOF is not one of them.

The report scoped the current standard of data recording in this domain and drew attention to the frequent under-identification and sub-optimal care of patients at risk of fragility fractures and falls.

We suggested that since guidance from many sources, including NICE, had failed to change this, the incorporation of indicators in the QOF probably would and that it could be monitored accurately.

The QOF indicators suggested are available for inspection on the National Osteoporosis Society's website ( and are not the same as those listed in your article on glucocorticoid-induced osteoporosis and secondary fracture prevention for women aged 65 to 74.

An indicator for DXA referral for 65- to 74-year-olds, or indeed counting the number of patients on glucocorticoids, is largely pointless unless it is part of an intervention that is deliverable in general practice and has robust evidence for clinical and cost efficacy.

This has been highlighted in a recent BMJ editorial (Wald DS, Problems with performance-related pay in primary care, BMJ 2007).

Dr Jonathan Bayly, associate lecturer, University of Derby

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