An annual report card on clinic quality is now evaluating Minnesota doctors on their efforts to prevent osteoporosis — a rare area of medicine in which the state's doctors appear to be performing worse than their peers nationally.

MN Community Measurement, a nonprofit clinic rating agency, released its 2019 clinic ratings on Thursday, and for the first time ranked medical groups by the percentage of their older female patients who received recommended osteoporosis management after suffering broken bones.

The measure was added because osteoporotic bone fractures can cause long-term pain, lack of mobility and other resulting health problems, but also because Minnesota is below average in the use of recommended tests and treatments to prevent them, said Julie Sonier, executive director of MN Community Measurement.

"The data showed we were lagging the nation," she said. "There was significant variation among clinics and lots of opportunities for improvement."

MN Community Measurement has emerged as a force in Minnesota medicine, because doctors focus on the areas that it publicly measures. The rate of patients with asthma who receive optimal care has increased from 49.5% in 2017 to 53.3% in 2019. The rate of 2-year-olds who have received 10 recommended immunizations, including annual flu vaccines, increased in that time frame from 50.2% to 56.2%.

Scans, medications

In Minnesota, proper osteoporosis management is provided to only 31.5% of women aged 65 to 85 who are at risk for fractures after prior bone breaks, the measurement data showed. Proper management is defined as receiving a bone density scan, or a prescription to prevent or manage osteoporosis, within six months of major bone fractures. The national rate is more than 41%.

All 12 medical groups in the report received average grades, due to the statistical methods used to make their results comparable, but their scores varied. Mayo Clinic and North Memorial had rates of 46% and 44%, respectively, while the rate for St. Luke's Clinics was 22%.

The osteoporosis measure is backed by the National Quality Forum and was recommended by a board of experts who advise MN Community Measurement, but not without debate due to concerns about side effects of bisphosphonate pills, which are commonly prescribed to manage osteoporosis. Another concern is that women who have had bone density scans might not need repeat scans after fractures.

Digestive problems are common with bisphosphonate pills but can be addressed if patients take the pills with water and on empty stomachs. Long-term use also could result over time in bones becoming too brittle, though doctors have countered that side effect by only prescribing them in short bursts rather than in continuous doses, said Dr. Andrew Schmidt, chief of orthopedics at Hennepin Healthcare. Other drugs are now available that might strengthen bone density, he added.

Hennepin Healthcare provides data to MN Community Measurement but wasn't ranked for osteoporosis management. Schmidt couldn't speak to the validity of the measurement, but he said doctors have too often failed to recognize that older women need treatments to reduce their risks of osteoporosis after they suffer fractures. He said the measurement is providing needed attention, and he said Hennepin Healthcare has been part of a national Own the Bone consortium of hospitals that is seeking to improve osteoporosis prevention and treatment.

"It's hard to know why" some women aren't receiving preventive therapy, he said, "because everybody has heard of osteoporosis."