Common Sense Changes in Senior Bone Fracture Care Will Reduce Health Costs

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By Dr. Susan Greenspan, Director, Osteoporosis Prevention and Treatment Center and the Bone Health Program at the University of Pittsburgh School of Medicine

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. 

Congress and the Biden Administration can take a few common-sense steps that would reduce health care costs and save lives nationally and here in Pennsylvania. In fact, preventing only one in five 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. It also found that 82,000 Medicare beneficiaries in the Keystone state suffered 97,300 bone fractures linked to osteoporosis in 2016, and the cost to Medicare when those Pennsylvanians suffered a second fracture was over $228 million.   

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

  • More than 40 percent were hospitalized within one week after the fracture, across all types of fractures studied. Of those with a hip fracture, more than nine in tenwere 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.

The good news is, we have the tools to fix this problem. Medicare already pays for bone density testing to identify those at risk of bone fractures, allowing for 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 percent and cut repeat fractures by almost half. In addition, new models of coordinated, post-fracture care have proven effective at reducing fracture rates.

Unfortunately, we’re just not using the tools we have. Only seven percent of Pennsylvanians 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 percent being similarly screened. Other studies have shown that around 80 percent 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, CMS should incentivize the use of best practices for secondary fracture prevention and care coordination like the model used by Geisinger Health System here in Pennsylvania that raised fracture prevention treatment rates to over 70 percent among those at high risk.

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

Lastly, we’ve 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 Pennsylvanians 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. Susan Greenspan is director of the Osteoporosis Prevention and Treatment Center and the Bone Health Program at the University of Pittsburgh School of Medicine. She is the immediate past president of the National Osteoporosis Foundation.

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