Full Clinical Guidelines - Community First Health Plans.

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14.1 Management of Osteoporosis Traditionally, osteoporosis is a disease associated with menopause. It is thought to affect only women but men are also at risk for osteoporosis. The National Institutes of <strong>Health</strong> Osteoporosis and Related Bone Disease National Resource Center reports that: • Osteoporosis is a major public health threat for 44 million Americans, 68% of whom are women; • In the U.S. today, 10 million individuals already have osteoporosis and 34 million more have low bone mass, placing them at increased risk for this disease; • One out of every two women and one in four men over 50 will have an osteoporosis-related fracture in their lifetime; • More than 2 million American men suffer from osteoporosis, and millions more are at risk. Each year, 80,000 men suffer a hip fracture and one-third of these men die within a year; • Osteoporosis can strike at any age; • Estimated national direct expenditures (hospitals and nursing homes) for osteoporosis and related fractures are $14 billion each year. CFHP has adopted the Recommendations and the Guide to Prevention and Treatment from the National Osteoporosis Foundation. Osteoporosis is a preventable disease and with adherence to these recommendations, patients can reduce their risk for this disease and for those who already are affected by it, their outcomes can be improved. 108 H EALTH PLANS www.cfhp.com
Risk Factors for Osteoporosis Fractures www.nof.org Non-modifiable: • Personal history of fracture as an adult • History of fracture in first-degree relative • Caucasian/Asian race • Advanced age • Female sex • Dementia • Poor health/frailty Potentially Modifiable: • Current cigarette smoking • Low body weight (1 year) • Low calcium intake (lifelong) • Alcoholism • Impaired eyesight despite correction • Recurrent falls • Inadequate physical activity • Poor health/frailty • Use of corticosteroid therapy for >3 months The four items in boldface type are key factors in determining risk of hip fracture independent of BMD. Who should be tested? Your healthcare provider may recommend a bone mineral density (BMD) test if you are: • A postmenopausal woman under age 65 with one or more risk factors for osteoporosis • A man age 50-70 with one or more risk factors for osteoporosis • A woman age 65 or older, even without any risk factors • A man age 70 or older, even without any risk factors • A woman or man after age 50 who has broken a bone • A woman going through menopause with certain risk factors • A postmenopausal woman who has stopped taking estrogen therapy (ET) or hormone therapy (HT) Some other reasons your healthcare provider may recommend a BMD test: • Long-term use of certain medications including steroids (for example, prednisone and cortisone), some anti-seizure medications, Depo-Provera® and aromatase inhibitors (for example, anastrozole, brand name Arimidex®) • A man receiving certain treatments for prostate cancer • A woman receiving certain treatments for breast cancer • Overactive thyroid gland (hyperthyroidism) or taking high doses of thyroid hormone medication • Overactive parathyroid gland (hyperparathyroidism) • X-ray of the spine showing a fracture or bone loss • Back pain with a possible fracture • Significant loss of height • Loss of sex hormones at an early age, including early menopause • Having a disease or condition that can cause bone loss (such as rheumatoid arthritis or anorexia nervosa) National Osteoporosis Foundation. Physician’s guide to prevention and treatment of osteoporosis. Washington (DC): National Osteoporosis Foundation; 2008, p.13 Who should be treated? Postmenopausal women and men age 50 and older presenting with the following should be considered for treatment: • A hip or vertebral (clinical or morphometric) fracture • T-score ≤ -2.5 at the femoral neck or spine after appropriate evaluation to exclude secondary causes • Low bone mass (T-score between -1.0 and -2.5 at the femoral neck or spine) and a 10-year probability of a hip fracture ≥ 3% or a 10-year probability of a major osteoporosis-related fracture ≥ 20% based on the US-adapted WHO algorithm 14.2 Recommendations from National Osteoporosis Foundation H EALTH PLANS www.cfhp.com 109
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10.5 ATP III Classification of Chol
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Such information is released only t
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Non Voting • Martin Jimenez, Dire
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The purpose of these guidelines is
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Table 1. Adult Preventive Services
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Recommended Adult Immunization Sche
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Footnotes — Recommended Adult Imm
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CFHP has adopted the National Asthm
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Patient Name ______________________
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Managing Asthma Long Term 41 FIGURE
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FIGURE 16. STEPWISE APPROACH FOR MA
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FIGURE 20. CLASSIFYING SEVERITY OF
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II. Some hyperactive-impulsive or i
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COMMUNITY FIRST HEALTH PLANS BEHAVI
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Criteria Requirements 33. Release o
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The evaluation of breast disease is
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Prevent Child Texas, a non-profit o
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AMERICAN ACADEMY OF PEDIATRICS: Fai
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possible), a careful, complete, and
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Examination/Test Oral / Dental Insp
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GLYCEMIC CONTROL BIBLIOGRAPHY • R
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Publication # 45-11647 Targets* A1
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WORKSHEET Revised 10-20-05 Advancin
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D. Optimizing analog insulin use Re
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Publication # 45-11266 Age 126 mg/d
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Hypertension Algorithm for Diabetes
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Page 79 and 80: Abbreviations AGI Alpha-Glucosidase
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Page 119 and 120: TEXAS MEDICAID PROVIDER PROCEDURES
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Page 141 and 142: FIGURE 2: Recommended immunization
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2 to 20 years: Boys Body mass index
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AsthmaMatters is an initiative deve
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According to the Centers for Diseas
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