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Pressure is mounting for quality points for osteoporosis in the next draft of the framework after a new study uncovered dramatic variation in the standard of practice records.

The study of 78 GP practices across England found differences of over 100-fold in the rates of recording of diagnostic codes, risk factors and treatment.

The National Osteoporosis Society (NOS) told Pulse it was submitting evidence to the quality framework review group to try to address the problem.

The new study, published online this week in Public Health, found the rate of recording of diagnostic codes varied from 0 to 97 per 1,000 patients over 50, while T-scores of bone mineral density were 'very infrequently recorded'.

Data quality had 'not reached the stage where osteoporotic patients can be identified reliably', the study concluded.

Study leader Dr Simon de Lusignan, senior lecturer in primary care at St George's Hospital Medical School and a GP in Guildford, Surrey, said: 'Osteoporosis records are where heart disease records were three or four years ago. Having a quality marker undoubtedly would be a powerful stimulus for improvement.

'If there was notice it was going to be in the QOF in 18 months' time then practices would have time to get their records organised. Given time to sort out the records it would be a very useful quality marker.'

The NOS told Pulse it was submitting evidence on the need for quality points for setting up registers of elderly patients in residential homes, those with a history of fractures or long-term users of oral steroids (see box).

The society also wants points for the percentage of patients treated for osteoporosis or the percentage of steroid users on bone-sparing agents.

Dr Jonathan Bayley, a member of the society's scientific advisory group, said: 'The NOS submission is to define at-risk groups and to deliver appropriate interventions as defined by NICE. The NOS believes drawing up disease registers is quite easily achievable.'

Dr de Lusignan said DEXA scans would need to be more widely available if osteoporosis became a quality marker.

Quality points for osteoporosis:

submission to the review panel


·Patients aged 75 or over living in a nursing or residential home

·Patients with a history of fragility fractures

·Patients over 65 with exposure to any dose of oral steroids for over three months


·Percentage of patients in a residential home getting calcium and vitamin D

·Percentage over 65 on steroids who are treated with a bone-sparing agent

·Percentage of women aged 65 to 74 with osteoporotic fractures and osteoporosis on a DEXA scan receiving bone-sparing agent

Source: National Osteoporosis Society

By Nerys Hairon

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