Opinion

Improving early detection and treatment of osteoporosis

Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue.  As the bones weaken, they may break from a fall or, in advanced cases, even from a simple sneeze or minor bump.  Taken from the Latin for “porous bone,” osteoporosis is often called “the silent disease” because bone loss usually occurs gradually over the years without symptoms.

Today, approximately 54 million Americans either have osteoporosis or low bone mass, which places them at increased risk for osteoporosis.  Women are disproportionally affected, accounting for 71 percent of osteoporotic fractures and 75 percent of costs.

The risk of osteoporosis increases as we age.  Studies suggest that approximately one-half of women and one-fourth of men age 50 or older will suffer a bone fracture due to osteoporosis.  According to the National Osteoporosis Foundation, the disease is responsible for 2 million bone fractures and $19 billion in medical costs every year.  As our population ages, it is estimated that osteoporosis will be responsible for 3 million fractures and more than $25 billion in costs by 2025.

As the Osteoporosis and Related Bone Disease National Resource Center of the National Institutes of Health observes, falls are especially dangerous for people who are unaware that they have low bone density.  If the patient and the doctor fail to connect the broken bone to osteoporosis, the chance to make a diagnosis with a bone density test and begin a prevention or treatment program is lost.

Early diagnosis and treatment of osteoporosis are proven to dramatically reduce fracture rates.  Since those most at risk are often seniors receiving health care coverage through Medicare, it is essential that Medicare reimbursement rates adequately cover the tests that measure bone mass and predict fracture risk, particularly in rural or underserved areas.

Unfortunately, Medicare reimbursement rates are not adequate — in fact, they’ve been moving in the wrong direction.  Over the past decade, Medicare reimbursement for osteoporosis screening has greatly declined from $140 in 2007 to $42 in 2018 — a dramatic 70 percent reduction.  As a result of reduced screening due to declining reimbursements, it is estimated that more than 40,000 additional hip fractures occur each year, resulting in nearly 10,000 additional hip-fracture deaths.

In addition, the National Osteoporosis Foundation has found that declining reimbursement rates have created a 26 percent decline in physicians performing dual-energy x-ray absorptiometry (DXA) tests — the “gold standard” for screening — since 2008.  This resulted in a corresponding 22 percent decline in diagnoses since 2009.

I have introduced bipartisan legislation to lessen this barrier to proper screening.  The Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act would create a floor reimbursement rate under Medicare Part B for the DXA test.

Congress has twice recognized the importance of reversing Medicare cuts to DXA reimbursement in order to maintain patient access, yet the Medicare reimbursement rate for DXA tests administered in a doctor’s office has been cut significantly.  As osteoporosis is already under-diagnosed in the Medicare population, it is clear that we must change this trajectory.

This legislation is endorsed by the American Association of Clinical Endocrinologists, the National Osteoporosis Foundation, and more than 40 additional national medical societies and patient advocate organizations.  Increasing Medicare reimbursement to an adequate level will increase patient access to osteoporosis screening and diagnosis, while lowering costs and consequences resulting from a lack of diagnosis.

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