Advertisement

Archives of Osteoporosis

, 13:41 | Cite as

Do reductions in out-of-pocket expenses for dual energy X-ray absorptiometry scans translate to reduced fracture incidence amongst older Australians? A population-based study

  • Amanda L. Stuart
  • Sharon L. Brennan-Olsen
  • Julie A. Pasco
  • Amelia G. Betson
  • Kara L. Holloway-Kew
  • Sarah M. Hosking
  • Lana J. Williams
Short Communication

Abstract

Summary

This study aimed to compare fracture incidence in the elderly pre- and post-revision of bone density scan reimbursement guidelines, which changed in 2007. Fracture incidence by age group was calculated using population-specific data. Guideline changes did not appear to reduce fracture incidence in the study region located in south-eastern Australia.

Purpose

In 2007, Medicare Australia revised reimbursement guidelines whereby individuals aged 70 years and over received reduced out-of-pocket expenses for dual energy X-ray absorptiometry (DXA) scans. The current study aims to determine whether fracture incidence in the elderly has changed since the revision of reimbursement guidelines.

Method

Keyword searches of the two major radiological centres servicing the Barwon Statistical Division (BSD) were used to identify incident fractures for residents aged 75 years and over for 2006 and 2012. Pathological fractures were excluded. Fracture incidence by age strata (75–79 years, 80–84 years and 85+ years) were calculated using population-specific data from the Australian Bureau of Statistics (2006 and 2012). Standardised fracture ratios were calculated for men and women.

Results

In total, 996 fracture events were identified for BSD residents during 2006 and 1260 identified in 2012. The standardised fracture ratios between 2006 and 2012 were 1.12 (95%CI 1.11, 1.25) for men and 1.08 (95%CI 1.11, 1.16) for women.

Conclusion

The change in reimbursement guidelines appears to have had little impact on reducing fracture incidence during this time frame for elderly men and women, in fact, fracture rates increased. Future research should investigate osteoporosis management following DXA over a longer time frame.

Keywords

Fracture incidence Policy evaluation Reimbursement Bone mineral density 

Notes

Funding information

The study was supported by the Australian National Health and Medical Research Council (NHMRC; project 628582), the Geelong Region Medical Research Foundation and Amgen Europe (GmBH); however, the funding bodies played no part in the design or conduct of the study, the collection, management, analysis and interpretation of the data or in the preparation or review of the manuscript. SLB-O and LJW are supported by a National Health and Medical Research Council (NHMRC) Career Development Fellowships (1107510 and 1064272, respectively) and KLH-K is supported by an Alfred Deakin Postdoctoral Research Fellowship.

Compliance with ethical standards

Conflict of interest

None.

References

  1. 1.
    Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9(8):1137–1141CrossRefPubMedGoogle Scholar
  2. 2.
    WHO (2004) WHO scientific group on the assessment of osteoporosis at primary health care level, Summary meeting report. World Health Organisation, BelgiumGoogle Scholar
  3. 3.
    Watts JJ, Abimanyi-Ochom J, Sanders KM (2013) Osteoporosis costing all Australians: a new burden of disease analysis—2012 to 2022, O. Australia, Editor. Melbourne, OsteoporosisGoogle Scholar
  4. 4.
    Australia, DoH, Schedule of pharmaceutical benefits for approved pharmacists and medical pracitioners 1 April 2007Google Scholar
  5. 5.
    Australia, DoH, Medicare benefits schedule. 1 November 2006Google Scholar
  6. 6.
    Brennan SL, Kotowicz MA, Sarah B, Leslie WD, Ebeling PR, Metge CJ et al (2013) Examining the impact of reimbursement on referral to bone density testing for older adults: 8 years of data from the Barwon Statistical Division, Australia. Arch Osteoporos 8:152CrossRefPubMedGoogle Scholar
  7. 7.
    Dobbins AG, Brennan SL, Williams LJ, Kotowicz MA, Sarah B, Birch Y et al (2014) Who are the older Australians referred for a bone density scan? Data from the Barwon region. Arch Osteoporos 9:196CrossRefPubMedGoogle Scholar
  8. 8.
    Pasco JA, Nicholson GC, Kotowicz MA (2012) Cohort profile: Geelong Osteoporosis Study. Int J Epidemiol 41:1565–1575CrossRefPubMedGoogle Scholar
  9. 9.
    Pasco JA, Henry MJ, Gaudry TM, Nicholson GC, Kotowicz MA (1999) Identification of incident fractures: the Geelong Osteoporosis Study. Aust NZ J Med 29(2):203–206CrossRefGoogle Scholar
  10. 10.
    Pasco JA, Lane SE, Brennan-Olsen SL, Holloway KL, Timney EN, Bucki-Smith G et al (2015) The epidemiology of incident fracture from cradle to senescence. Calcif Tissue Int 97(6):568–576CrossRefPubMedGoogle Scholar
  11. 11.
    Australian Bureau of Statistics. Estimated resident population by age and sex, statistical area level 2, in ABS.stat. 2006 and 2012, Commonwealth of AustraliaGoogle Scholar
  12. 12.
    Inderjeeth C, Smeath A (2010) Bones beyond 70—insights into osteoporosis management in the elderly. Aust Fam Physician 39(10):767–772PubMedGoogle Scholar
  13. 13.
    Otmar R, Reventlow SD, Nicholson GC, Kotowicz MA, Pasco JA (2012) General medical practitioners’ knowledge and beliefs about osteoporosis and its investigation and management. Arch Osteoporos 7(1–2):107–114CrossRefPubMedGoogle Scholar
  14. 14.
    Henry MJ, Pasco JA, Nicholson GC, Kotowicz MA (2011) Prevalence of osteoporosis in Australian men and women: Geelong Osteoporosis Study. Med J Aust 195(6):321–322CrossRefPubMedGoogle Scholar
  15. 15.
    Kanis JA, Svedbom A, Harvey N, McCloskey EV (2014) The osteoporosis treatment gap. J Bone Miner Res 29(9):1926–1928CrossRefPubMedGoogle Scholar
  16. 16.
    Willson T, Nelson SD, Newbold J, Nelson RE, LaFleur J (2015) The clinical epidemiology of male osteoporosis: a review of the recent literature. Clin Epidemiol 7:65–76PubMedPubMedCentralGoogle Scholar
  17. 17.
    Otmar R, Henry MJ, Kotowicz MA, Nicholson GC, Korn S, Pasco JA (2011) Patterns of treatment in Australian men following fracture. Osteoporos Int 22(1):249–254CrossRefPubMedGoogle Scholar
  18. 18.
    Pasco JA, Seeman E, Henry MJ, Merriman EN, Nicholson GC, Kotowicz MA (2006) The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int 17(9):1404–1409CrossRefPubMedGoogle Scholar
  19. 19.
    Osteoporosis Australia Medical & Scientific Advisory Committee. Therapeutic Management. Healthcare Professionals 2014 22/11/2016]; Available from: http://www.osteoporosis.org.au/therapeutic-management
  20. 20.
    Sanders KM, Nicholson GC, Watts JJ, Pasco JA, Henry MJ, Kotowicz MA et al (2006) Half the burden of fragility fractures in the community occur in women without osteoporosis. When is fracture prevention cost-effective? Bone 38(5):694–700CrossRefPubMedGoogle Scholar
  21. 21.
    Pasco JA, Brennan SL, Henry MJ, Nicholson GC, Sanders KM, Zhang Y et al (2011) Changes in hip fracture rates in south-eastern Australia spanning the period 1994-2007. J Bone Miner Res 26(7):1648–1654CrossRefPubMedGoogle Scholar
  22. 22.
    Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM et al (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–1288CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    SOS Fracture Alliance. Strategic plan 2017–2019. 2017: www.sosfracturealliance.org.au

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Amanda L. Stuart
    • 1
  • Sharon L. Brennan-Olsen
    • 2
    • 3
  • Julie A. Pasco
    • 1
    • 4
    • 5
  • Amelia G. Betson
    • 1
  • Kara L. Holloway-Kew
    • 1
  • Sarah M. Hosking
    • 1
    • 2
  • Lana J. Williams
    • 1
  1. 1.IMPACT Strategic Research Centre, School of MedicineDeakin UniversityGeelongAustralia
  2. 2.Australian Institute for Musculoskeletal Science (AIMSS)The University of MelbourneMelbourneAustralia
  3. 3.Australian Health Policy CollaborationMelbourneAustralia
  4. 4.Department of Clinical EpidemiologyMonash UniversityPrahranAustralia
  5. 5.Melbourne Medical School-Western CampusThe University of MelbourneMelbourneAustralia

Personalised recommendations