Dr. Mark Olson: Osteoporosis reforms will save money, improve care

By Dr. Mark Olson

Osteoporosis, or weakening of the bones, is not often included in discussions of major health policy concerns, yet bone fractures due to osteoporosis are responsible for more hospitalizations than heart attacks, strokes or breast cancer. They are also costly. The direct medical costs of Medicare beneficiaries who suffer two or more bone fractures was $5.7 billion over a three-year period nationwide and $107.5 million in Washington state.

The good news is, Congress and the Biden administration can take a few common-sense steps that would both reduce health care costs and save lives here in Washington and nationally. In fact, preventing only 1 in 5 of secondary fractures could save Medicare over $1 billion in two to three years.

A new study from the National Osteoporosis Foundation found that about 1.8 million Medicare beneficiaries suffered approximately 2.1 million osteoporotic fractures in 2016. In Washington state, 37,000 Medicare beneficiaries suffered 42,300 bone fractures linked to osteoporosis, and the cost to Medicare when those Washingtonians suffered a second fracture was more than $107 million.

Nationally, for those patients within traditional Medicare (not including those in Medicare Advantage plans) who suffered an osteoporotic fracture:

· More than 40% were hospitalized within one week after the fracture, across all types of fractures studied. Of those with a hip fracture, more than 9 in 10 were hospitalized within a week.

· They had twice the annual rate of debilitating and costly new pressure ulcers after adjusting for age and sex.

· Almost 42,000 became institutionalized in nursing homes within three years, as the debilitating post-fracture effects required the custodial care provided in a nursing home.

Not surprisingly, the impact of osteoporosis is expected to grow as the baby boomers age. Another recent study found that the total annual cost for osteoporotic fractures among Medicare beneficiaries was $57 billion in 2018 and is expected to grow to over $95 billion in 2040.

We have the tools to fix this problem. Medicare already pays for state-of-the-art bone density testing to identify those at risk of bone fractures, allowing for early and effective preventive steps and interventions. Medicare also pays for FDA-approved drug treatments for osteoporosis that can help reduce spine and hip fractures by up to 70% and cut repeat fractures by about half. In addition, new models of coordinated, post-fracture care have proven effective at reducing fracture rates.

Unfortunately, we are just not using the tools we have. Only 9% of Washingtonians in traditional Medicare received bone density screening within six months of suffering an osteoporotic fracture. And screening rates for Black beneficiaries in our state were even lower, with just 3.8% being screened. Other studies have shown that around 80% of those who have suffered a fracture have not received effective drug therapies to help prevent additional fractures.

There are three steps Congress and the Biden administration can take to address the problem. First, the Centers for Medicare & Medicaid Services should incentivize the use of best practices for secondary fracture prevention and care coordination like the model used by Geisinger Health System in Pennsylvania that raised fracture prevention treatment rates to over 70% among those at high risk.

Second, cuts to Medicare payment rates for osteoporosis screening should be reversed. In the past five years, osteoporosis diagnosis in older women has declined by 18% . This is not because osteoporosis has become less common, but because screening payment rates have been cut by 70% .

Lastly, we have made great progress against heart disease and other conditions through awareness campaigns. Congress should create and fund a national education and action initiative aimed at reducing fractures among older Americans. Setting national goals for the prevention of osteoporosis and fractures and prioritizing reduction of racial disparities will have a meaningful impact.

We know how to help Washingtonians who suffer from osteoporosis, and the necessary reforms will save taxpayers billions and help keep Medicare solvent. I hope others in our state will join me in calling on our representatives, senators and the Biden administration to take these common-sense steps.

Dr. Mark Olson is an orthopedic surgeon in Spokane who specializes in bone health and osteoporosis examination and treatment.