Osteoporosis Management in Women and Preventing Fractures (OMW)

Osteoporosis is commonly underdiagnosed and undertreated. Osteoporosis may present minor symptoms, or even be asymptomatic in the early stages. Many people are unaware they have this condition, which may become serious. A fracture may be an indicator of osteoporosis. Screening and subsequent medication treatment for osteoporosis can significantly improve health and prevent fractures.

When should I provide bone mineral density testing?The United States Preventive Services Task Force (USPSTF) recommends all women ages 65 and older routinely have a bone mineral density (BMD) test to screen for osteoporosis. A BMD test is also recommended when men and women ages 50 and older break a bone.

Make sure that all women ages 67—85 who have su�ered a fracture complete a BMD test or fill a medication for osteoporo-sis treatment within six months.

BMD tests are the most e�ective method for determining bone health, identifying osteoporosis, determining risk for fractures, and assessing response to osteoporosis treatment.

Does Meridian cover a BMD test?Meridian covers BMD testing. To find a hospital or radiology center, check the Provider Directory at www.mhplan.com.

Fax bone mineral density test resultsto 313-202-0006

For further questions, please call Meridian's Quality Improvement department at 888-437-0606

Visit the Provider Portal at hpprovider.atlascomplete.com to enter relevant Healthcare E�ectivness Data and Information Set (HEDIS®) information

FDA-Approved Osteoporosis Therapies*

Recommended pharmacologic options for osteoporosis treatment include:

*Not all medications may be covered. For a list of covered medications, refer to the Meridian Drug Formulary at www.mhplan.com

Contact Information:For questions regarding the Meridian Drug Formulary, please call MeridianRx at 855-323-4580.

EDPS39 MI CORP | www.mhplan.com

CPT ICD-10-CM Procedure

76977, 77078, 77080, 77081, 77085, 77086

Codes to bill for BMD testing:

BP48ZZ1, BP49ZZ1, BP4GZZ1, BP4HZZ1, BP4LZZ1, BP4MZZ1, BP4NZZ1, BP4PZZ1, BQ00ZZ1, BQ01ZZ1, BQ03ZZ1, BQ04ZZ1, BR00ZZ1, BR07ZZ1, BR09ZZ1, BR0GZZ1

M

ERIDIAN

PA S S P O RT

Codes listed are specific to the subject matter of this flyer. While Meridian encourages you to use these codes in association with the subject matter of this flyer, Meridian recognizes that the circumstances around the services provided may not always directly support/match the codes. It is crucial that the medical record documentation describes the services rendered in order to support the medical necessity and use of these codes.

Bisphosphonates Alendronate Risedronate Alendronate-cholecalciferol Zoledronic acid Ibandronate

Other agents Abaloparatide Raloxifene Denosumab Teriparatide

Janu

ary

2020

Elig

ible

Pop

ulat

ion

Key

Com

pone

nts

Freq

uenc

y

A

ge

Sex

Wei

ght (

kg)

H

eigh

t (cm

)

Pre

viou

s fra

ctur

e

Par

ent f

ract

ured

hip

C

urre

nt s

mok

ing

G

luco

corti

coid

s

Rhe

umat

oid

arth

ritis

S

econ

dary

ost

eopo

rosi

s [ty

pe 1

dia

bete

s, o

steo

gene

sis

impe

rfect

a in

adu

lts, u

ntre

ated

long

-sta

ndin

g hy

perth

yroi

dism

,

hy

pogo

nadi

sm o

r pre

mat

ure

men

opau

se (<

45 y

ears

), ch

roni

c

m

alnu

tritio

n, o

r mal

abso

rptio

n, a

nd c

hron

ic li

ver d

isea

se)

A

lcoh

ol 3

or m

ore

units

per

day

(see

FR

AX®)

Fe

mor

al n

eck

BM

D (g

/cm

2 )

Oth

er ri

sk fa

ctor

sV

itam

in D

def

icie

ncy

or lo

w d

ieta

ry c

alci

um in

take

Inad

equa

te p

hysi

cal a

ctiv

ityLo

ss o

f hei

ght (

1.5

inch

es)

Fam

ily h

isto

ry o

f ost

eopo

rosi

sD

epo-

Pro

vera

use

Aro

mat

ase

inhi

bito

r the

rapy

And

roge

n in

hibi

tor t

hera

pyLu

pron

ther

apy

Cor

e P

rinci

ples

of

Prim

ary

Pre

vent

ion

Ther

e is

insu

ffici

ent

evid

ence

on

the

optim

al

scre

enin

g in

terv

al in

a

wom

an w

ith p

revi

ous

norm

al B

MD

Pat

ient

Sel

ectio

n fo

r Pha

rmac

olog

ical

M

anag

emen

t B

ased

on

Ris

k

MQ

IC.O

RG

1 Use

cau

tion

in p

atie

nts

with

act

ive

uppe

r GI d

isor

ders

. Tak

e m

edic

atio

n on

an

empt

y st

omac

h w

ith w

ater

, rem

ain

uprig

ht, n

o fo

od o

r bev

erag

e fo

r 30

min

utes

, (60

min

utes

for I

band

rona

te).

Iden

tify

risk

fact

ors

Ass

ess

risk

fact

ors.

[C] C

alcu

late

FR

AX®

to a

sses

s fu

ture

frac

ture

risk

. Inc

lude

bon

e m

iner

al d

ensi

ty (B

MD

) whe

n av

aila

ble.

Rec

ord

resu

lt.A

dult

heig

ht

asse

ssm

ents

at

perio

dic

wel

l exa

ms

Opt

imiz

e di

etar

y ca

lciu

m (1

000-

1200

mg/

d) a

nd v

itam

in D

(≥ 1

000

IU/d

). O

nly

use

supp

lem

ents

if d

iet i

s in

suffi

cien

t.P

harm

acol

ogic

al

Man

agem

ent

M

ichi

gan

Qua

lity

Impr

ovem

ent

Con

sort

ium

Gui

delin

e

Man

agem

ent

and

Prev

enti

on o

f Ost

eopo

rosi

s

Appr

oved

by

MQ

IC M

edic

al D

irect

ors

2003

, 200

6, 2

008,

201

0, 2

012,

201

4, 2

016,

201

8, 2

020

The

follo

win

g gu

idel

ine

reco

mm

ends

ass

essm

ent a

nd m

anag

emen

t of p

atie

nts

to re

duce

frac

ture

risk

due

to o

steo

poro

sis.

2 J of

Bon

e M

etab

olis

m N

ov 2

015

Dru

g H

olid

ays

and

Prin

cipl

es o

f Mon

itorin

gLe

vels

of E

vide

nce

for t

he m

ost s

igni

fican

t rec

omm

enda

tions

: A =

rand

omiz

ed c

ontro

lled

trial

s; B

= c

ontro

lled

trial

s, n

o ra

ndom

izat

ion;

C =

obs

erva

tiona

l stu

dies

; D =

opi

nion

of e

xper

t pan

el

Rec

omm

enda

tion

and

Leve

l of E

vide

nce

This

gui

delin

e re

pres

ents

cor

e m

anag

emen

t ste

ps. I

t is

base

d on

Qas

eem

A, F

orci

ea M

A, M

cLea

n R

M, D

enbe

rg T

D, f

or th

e C

linic

al G

uide

lines

Com

mitt

ee o

f the

Am

eric

an C

olle

ge o

f Phy

sici

ans.

Tre

atm

ent o

f Low

Bon

e D

ensi

ty o

r Ost

eopo

rosi

s to

Pre

vent

Fra

ctur

es

in M

en a

nd W

omen

: A C

linic

al P

ract

ice

Gui

delin

e U

pdat

e Fr

om th

e Am

eric

an C

olle

ge o

f Phy

sici

ans.

Ann

Inte

rn M

ed. 2

017;

166:

818–

839.

doi

: 10.

7326

/M15

-136

1; F

inal

Rec

omm

enda

tion

Stat

emen

t: O

steo

poro

sis

to P

reve

nt F

ract

ures

: Scr

eeni

ng. U

.S. P

reve

ntiv

e S

ervi

ces

Task

For

ce. J

uly

2019

.. In

divi

dual

pat

ient

con

side

ratio

ns a

nd a

dvan

ces

in m

edic

al s

cien

ce m

ay s

uper

sede

or m

odify

thes

e re

com

men

datio

ns.

The

role

of c

alci

um a

nd v

itam

in D

sup

plem

enta

tion

is u

ncle

ar.

Sup

plem

enta

tion

is n

ot a

ssoc

iate

d w

ith re

duce

d fra

ctur

e ris

k an

d is

not

re

com

men

ded

for p

rimar

y pr

even

tion.

Wei

ght-b

earin

g ex

erci

se [A

]A

ddre

ss m

odifi

able

risk

fact

ors

abov

e, in

clud

ing

not s

mok

ing

or d

rinki

ng to

o m

uch

alco

hol

Fall

prev

entio

nTr

eat p

atie

nts

on c

ortic

oste

roid

ther

apy

with

a T

-sco

re ≤

-1.0

. [A]

Trea

t pat

ient

s w

ith a

his

tory

of a

n os

teop

orot

ic fr

actu

re o

r fra

ctur

e of

the

hip

or s

pine

. [A]

Trea

t pat

ient

s w

ithou

t a h

isto

ry o

f fra

ctur

es b

ut w

ith a

T-s

core

of -

2.5

or lo

wer

. [A]

Trea

t pat

ient

s w

ith a

T-s

core

bet

wee

n -1

.0 a

nd -2

.5 if

FR

AX®

maj

or o

steo

poro

tic fr

actu

re p

roba

bilit

y is

≥ 2

0% o

r hip

frac

ture

pro

babi

lity

is

≥ 3

%. [

D]

Per

form

BM

D te

stin

g us

ing

dual

-ene

rgy

x-ra

y ab

sorp

tiom

etry

(DXA

) for

:

Wom

en ≥

65

year

s re

gard

less

of r

isk

fact

ors

[D]

M

en/w

omen

with

frac

ture

risk

(10-

year

pro

babi

lity

of fr

actu

re u

sing

FR

AX® ≥

9.3%

)

On

corti

cost

eroi

ds

Tran

spla

nt

CT

scan

for s

cree

ning

is n

ot re

com

men

ded.

Con

side

r ora

l bis

phos

phon

ate

ther

apy1 . A

dru

g ho

liday

may

be

cons

ider

ed a

fter 3

-5 y

ears

2 in

low

-ris

k (6

-10

year

s in

hig

h-ris

k). I

f not

tole

rate

d

or in

effe

ctiv

e, c

onsi

der o

ther

age

nts.

Con

side

r ref

erra

l to

endo

crin

e or

bon

e an

d m

iner

al m

etab

olis

m s

peci

alis

t if p

atie

nt d

oes

not t

oler

ate

treat

men

t or s

how

s pr

ogre

ssio

n or

re

curr

ent f

ract

ure

afte

r 2 y

ears

on

treat

men

t.

Pat

ient

s re

quiri

ng

ther

apy

to re

duce

hig

h ris

k of

non

-trau

mat

ic

fract

ures

Pat

ient

s at

po

tent

ial r

isk

for

oste

opor

osis