Osteoporosis is medical condition that affects bone strength. The body is constantly breaking down old bone and building new bone, but as you age your body breaks down more old bone than it creates new bone. As a result, bones can become weak and may break from a fall, or in more serious cases from minor bumps or even sneezing.
“There are literally no symptoms [of osteoporosis], until you break a bone,” said Dr. Seth Coren, a Vero Beach orthopaedic surgeon who specializes in diagnosing and treating the disease. “According to the National Osteoporosis guidelines, post-menopausal women over 65 should be screened with a bone density scan every two years. If you’re post-menopausal and have a fracture of the spine, hip, wrist or forearm, your risk for osteoporosis is higher and you should get screened once a year. Diabetics are also at a higher risk because their bones are denser, but not as strong.”
While the disease is usually caused by a drop-in estrogen after menopause, certain medications can also bring on osteoporosis in both men and women.
“I started focusing on the diagnosis and treatment of osteoporosis about three or four years ago,” Dr. Coren says. “Most orthopaedics don’t treat osteoporosis because it takes a lot of time to evaluate and treat a patient, and for somebody with a busy surgical practice it is not something they are trained to do or want to do. One of the problems is that patients who have these fractures are not followed up with a bone density scan and their chances of a second break are high.”
The cost of treating osteoporosis is staggering. The disease affects about 1.8 million Medicare beneficiaries with approximately 2.1 million osteoporotic fractures nationally each year.
Those bone fractures due to osteoporosis are responsible for more hospitalizations than heart attacks, strokes or breast cancer. A recent study found that the total annual cost for osteoporotic fractures among Medicare beneficiaries was $57 billion in 2018, and it’s expected to grow to over $95 billion in 2040.
Florida is hotspot for the disease. A study from the National Osteoporosis Foundation found that Florida has the second highest fracture rate in the nation among those on Medicare. In 2016 there were 144,000 Medicare beneficiaries in the state who suffered 172,500 bone fractures linked to osteoporosis. The cost to Medicare just to treat second fractures suffered by Floridians was nearly $470.3 million.
The good news is that the medical community has the tools to help reduce the incidence of fractures due to osteoporosis, but doctors and nurses need assistance from the government.
Dr. Coren, who serves as an ambassador for the National Osteoporosis Foundation, has worked with the foundation to map out a three-step strategy prevent fractures.
“Medicare already pays for bone density testing to identify those at risk of bone fractures, allowing for preventative steps and intervention,” Dr. Cohen explained.
“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. Plus, there are new models of coordinated, post-fracture care that have proven effective at reducing fracture rates. Unfortunately, though, we’re just not using the tools we have.
“Only 9 percent of Florida residents 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 5 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 a few commonsense steps that would reduce healthcare costs and save lives both nationally and here in Florida. In fact, preventing only one in five of secondary fractures could save Medicare over $1 billion in two to three years.”
The first step Dr. Coren suggests is for Congress to direct the Centers for Medicare and Medicaid Services to incentivize the use of the best practices for secondary fracture prevention and care coordination. Methods used by the well-respected Geisinger Health System in Pennsylvania, which increased fracture prevention treatment rates to over 70 percent among those at high risk, could serve as a model for the national program.
The Geisinger Health System stresses the importance of getting bone density tests that measure bone strength by comparing your X-ray with that of an average healthy young adult.
Your bone density, or T-score, will determine your risk for a broken bone. The lower your T-score, the greater your fracture risk. Once your doctor knows the condition of your bones, he can decide what treatment is best for you based on your T-score, or degree of osteoporosis.
That treatment may include lifestyle changes, medication and exercise.
Secondly, 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. Bone density screening has become a money-losing proposition for medical facilities administering the scans, so they simply aren’t done enough.
And finally, 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 would have a meaningful impact, according to Dr. Coren.
“We already know how to help Floridians who suffer from osteoporosis and the necessary reforms will save taxpayers billions and help keep Medicare solvent,” he concluded. “I hope others in our state will join me in calling on our representatives, senators and the Biden Administration to take these commonsense steps.”
Dr. Seth Coren practices with Vero Orthopaedics. He received his medical degree from the State University of New York and completed his general surgical internship and orthopaedic residency at the University of Miami. He is board-certified in orthopaedic surgery and has been practicing orthopaedics in Indian River County since 1979. Call 772-569-2330 or schedule an appointment online at www.veroortho.com.
