To Fix Medicare Spending, Prevent Fractures Among Aging Americans

By Kenneth Lyles, MD, and Mary L. Bouxsein, PhD

As the White House and Congress prepare for negotiations over the budget and U.S. debt ceiling, there has been a lot of talk about how to pay for senior healthcare and the future of Medicare. Policymakers should consider starting with steps that can both save money within the Medicare system and improve the care received by seniors.

One of those steps is preventing fractures among older Americans. Fractures from osteoporosis are more prevalent than breast cancer, heart disease, or diabetes, and the consequences can be just as catastrophic. Almost one in six Americans are at increased risk of a fracture due to osteoporosis or low bone mass. Each year, 1.8 million Medicare beneficiaries suffer more than 2 million osteoporotic fractures, which lead to 432,000 hospital admissions and 180,000 nursing home admissions.

Unless we make significant, systemwide changes to prioritize fracture prevention, we can expect fractures to increase almost 70% by 2040, which comes with a hefty price tag. In 2018, the total cost of providing care for osteoporotic fractures was approximately $57 billion. By 2040, those costs are expected to exceed $95 billion.

Failing to prevent osteoporotic fractures is a lose-lose proposition, yet most first-fracture patients receive no osteoporosis testing or medication. This is despite our institutional knowledge that people over the age of 50 who break a bone likely have osteoporosis and are at high risk for another fracture.

When osteoporosis is caught early, we have highly effective treatments that can reduce a person’s risk of fracture. By thinking about an osteoporotic fracture as a “bone attack,” it becomes obvious that follow-up care to assess fracture risk and to diagnose and treat osteoporosis is as important as statins and beta-blockers are in preventing heart attacks.

For decades, fracture liaison services have been recognized internationally as the gold-standard intervention for reducing costly osteoporotic fractures. Yet the Centers for Medicare & Medicaid Services (CMS) and other payers have not recognized them as a set of services for reimbursement purposes.

Fracture liaison service programs identify patients who have likely suffered an osteoporotic fracture and proactively engage with them to communicate the importance of follow-up care. Patients receive diagnostic testing to assess the risk of a future fracture. The program also coordinates with other providers to develop a treatment plan, address fall risk, make sure physical therapy and other services are provided, and ensure that patients and caregivers understand that they can significantly reduce the risk of new fractures with proper care.

We hear the story over and over: A mother, father, grandparent, or other aging loved one was enjoying an active retirement after decades of hard work. Then, a fall causes a hip fracture, and everything changes. Many families have been hit hard by just this occurrence, struggling to care for a loved one who can no longer fully care for themselves.

Hip fractures make up more than half of osteoporotic fracture hospitalizations. In the first year following a hip fracture, about a third of previously independent individuals will end up in a nursing home, two in five will be unable to walk independently, and one in four will not survive the year.

It’s clear that patients need and deserve better post-fracture care, and that preventing additional fractures will save lives and money. That’s why the Bone Health and Osteoporosis Foundation, the American Society for Bone and Mineral Research, and more than 30 specialty societies are calling on CMS to use their authority to establish a single reimbursement code for fracture liaison services provided as post-fracture care.

We have the tools to allow patients to retain their independence, quality of life, and ability to participate in the activities they enjoy. It is time we stop accepting the devastating impact of osteoporotic fractures as an inevitable part of aging.

Kenneth Lyles, MD, is president of the Bone Health and Osteoporosis Foundation and a professor of medicine at the Duke University School of Medicine. Mary L. Bouxsein, PhD, is president of the American Society for Bone and Mineral Research and a professor of orthopedic surgery at Harvard Medical School.