Osteoporosis International

, 19:1505 | Cite as

Osteoporosis care at risk in the United States

Opinion Paper

Abstract

Osteoporotic fractures are associated with significant morbidity, mortality, and healthcare expenses. The United States (US) Surgeon General has described osteoporosis as a major public health concern that is underdiagnosed and undertreated. US federal agencies have established funding for bone density testing and put methodologies in place to monitor physician performance in the care of patients with osteoporosis. The US Centers for Medicare and Medicaid Services (CMS) has established bone density testing as a key preventive medical service and encouraged patients to have this test when first enrolling in Medicare. However, recent CMS actions have reduced reimbursement for dual-energy X-ray absorptiometry (DXA) to levels that are below the cost of providing this service at many facilities. As a consequence, it is likely that the number of DXA facilities in the US will decrease, thereby limiting patient access to an important diagnostic service and resulting in fewer patients being diagnosed and treated to reduce fracture risk. Unless there is a reversal of continuing reimbursement cuts for DXA, it is projected that future fracture rates will increase; the cost to Medicare for fracture-related care will be far greater than the savings in the cost of DXA services and medications to reduce fracture risk.

Keywords

CMS Diagnosis DXA Medicare Osteoporosis Reimbursement Treatment 

References

  1. 1.
    Klibanski A, Adams-Campbell L, Bassford T, Blair SN, Boden SD, Dickersin K, Gifford DR, Glasse L, Goldring SR, Hruska K, Johnson SR, McCauley LK, Russell WE, NIH Consensus Dev Panel Osteopor (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795CrossRefGoogle Scholar
  2. 2.
    Lewiecki EM, Laster AJ (2006) Clinical applications of vertebral fracture assessment by dual-energy X-ray absorptiometry. J Clin Endocrinol Metab 91:4215–4222CrossRefPubMedGoogle Scholar
  3. 3.
    Baim S, Wilson CR, Lewiecki EM, Luckey MM, Downs RW, Lentle BC (2005) Precision assessment and radiation safety for dual-energy X-ray absorptiometry: position paper of the international society for clinical densitometry. J Clin Densitom 8:371–378CrossRefPubMedGoogle Scholar
  4. 4.
    Lewiecki EM, Binkley N, Petak SM (2006) DXA quality matters. J Clin Densitom 9:388–392CrossRefPubMedGoogle Scholar
  5. 5.
    National Osteoporosis Foundation (2008) Clinician’s guide to prevention and treatment of osteoporosis. Available at http://www.nof.org/professionals/Clinicians_Guide.htm, accessed August 16, 2008
  6. 6.
    Kanis JA, on behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. 2007Google Scholar
  7. 7.
    National Osteoporosis Foundation (2002) America’s bone health: the state of osteoporosis and low bone mass in our nation. Available at http://nof.org/advocacy/prevalence/index.htm, accessed August 16, 2008
  8. 8.
    Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475CrossRefPubMedGoogle Scholar
  9. 9.
    Riggs BL, Melton LJ III (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17(Suppl):505S–511SCrossRefPubMedGoogle Scholar
  10. 10.
    Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ III (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005PubMedGoogle Scholar
  11. 11.
    US Department of Health and Human Services (2004) Bone health and osteoporosis: a report of the surgeon general. Available at http://www.surgeongeneral.gov/library/bonehealth/content.html, accessed August 16, 2008
  12. 12.
    Curtis JR, Carbone L, Cheng H, Hayes B, Laster AJ, Matthews R, Saag KG, Sepanski R, Tanner B, Womack C, Delzell E (2007) Longitudinal patterns in bone mass measurement among U.S. Medicare beneficiaries. J Bone Miner Res 22:S193Google Scholar
  13. 13.
    Foley KA, Foster SA, Meadows ES, Baser O, Long SR (2007) Assessment of the clinical management of fragility fractures and implications for the new HEDIS osteoporosis measure. Med Care 45:902–906CrossRefPubMedGoogle Scholar
  14. 14.
    Delmas PD, van de Langerijt L, Watts NB, Eastell R, Genant H, Grauer A, Cahall DL (2005) Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res 20:557–563CrossRefPubMedGoogle Scholar
  15. 15.
    Feldstein A, Elmer PJ, Orwoll E, Herson M, Hillier T (2003) Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures—a gap in evidence-based practice guideline implementation. Arch Intern Med 163:2165–2172CrossRefPubMedGoogle Scholar
  16. 16.
    van Staa TP, Kanis JA, Geusens P, Boonen A, Leufkens HG, Cooper C (2007) The cost-effectiveness of bisphosphonates in postmenopausal women based on individual long-term fracture risks. Value Health 10:348–357CrossRefPubMedGoogle Scholar
  17. 17.
    Cramer JA, Gold DT, Silverman SL, Lewiecki EM (2007) A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int 18:1023–1031CrossRefPubMedGoogle Scholar
  18. 18.
    Ettinger B, Pressman A, Schein J, Chan J, Silver P, Connolly N (1998) Alendronate use among 812 women: prevalence of gastrointestinal complaints, noncompliance with patient instructions, and discontinuation. J Manag Care Pharm 4:488–492Google Scholar
  19. 19.
    Siris ES, Harris ST, Rosen CJ, Barr CE, Arvesen JN, Abbott TA, Silverman S (2006) Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 81:1013–1022CrossRefPubMedGoogle Scholar
  20. 20.
    Department of Health and Human Services (1998) Medicare coverage of and payment for bone mass measurements. Fed Regist 63:34320–34328Google Scholar
  21. 21.
    US Preventive Services Task Force (2002) Screening for osteoporosis in postmenopausal women: recommendations and rationale. Ann Intern Med 137:526–528CrossRefGoogle Scholar
  22. 22.
    Medicare Preventive Services (2008) Available at http://www.medicare.gov/Health/osteoporosis.asp, accessed August 16, 2008
  23. 23.
    Department of Health and Human Services (2006) Coverage of Bone Mass Measurement (BMM) Tests. Fed Regist 71:49058–49060Google Scholar
  24. 24.
    Department of Health and Human Services: Centers for Medicare and Medicaid Services (2007) Fed Regist 72:66235Google Scholar
  25. 25.
    The Lewin Group (2007) Assessing the costs of performing DXA services in the office-based setting (survey data report prepared for American Association of Clinical Endocrinologists. International Society for Clinical Densitometry, The Endocrine Society, and American College of Rheumatology). Available at http://www.aace.com/advocacy/leg/pdfs/DXAExecutiveSummary.pdf, accessed August 16, 2008
  26. 26.
    Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, Silverman S (2008) Official positions of the International Society for Clinical Densitometry and executive summary of the 2007 position development conference. J Clin Densitom 11:75–91CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  1. 1.New Mexico Clinical Research and Osteoporosis CenterAlbuquerqueUSA
  2. 2.Colorado Center for Bone ResearchLakewoodUSA
  3. 3.Toni Stabile Osteoporosis CenterColumbia University Medical CenterNew YorkUSA

Personalised recommendations