Approximately 2.3 Million Fractures Suffered by 2 Million on Medicare; Proven Preventive Measures Go Largely Unused

Source NOF

A new report released today by the National Osteoporosis Foundation (NOF) finds that despite the existence of proven preventive measures, approximately 2 million Americans on Medicare suffered 2.3 million osteoporosis-related bone fractures in 2015. These totals mean osteoporotic fractures are responsible for more hospitalizations than heart attacks, strokes and breast cancer combined.  

The NOF contracted with the independent actuarial firm Milliman to conduct an analysis of the economic and clinical impact of bone fractures suffered by Americans in the Medicare program.  The analysis also provides insights on potential economic savings that could be realized if the rate of secondary (repeat) fractures were reduced through model prevention practices.

The report finds that bone fractures related to osteoporosis (“osteoporotic fractures”) take a large economic and human toll on our nation, but that reducing a small fraction of secondary fractures could yield large savings to Medicare Fee-for-Service (FFS):

• Approximately 2.3 million osteoporotic fractureswere suffered by 2 million Americans covered by Medicare in 2015.
• The additional cost in the 180-day period following a second fracture to Medicare FFS for the 307,000 beneficiaries who suffered a second fracture in the 2-3 years after an initial osteoporotic fracture and survived for at least 180 days after the second fracture was over $6.3 billion.   
• Only 9 percent of women covered by Medicare FFS who suffered an osteoporotic fracture were screened for osteoporosis with a bone mineral density test within six months following their fracture. 
• Over 40 percent of Medicare FFS beneficiaries with a new osteoporotic fracture were hospitalized within a week after their fracture and nearly 20 percent died within 12 months following a new osteoporotic fracture.
• The report concludes that reducing between 5 percent and 20 percent of these “secondary” fractures in 2015 could have reduced Medicare FFS spending by $310 million to $1.2 billion over a follow-up period that lasted up to 2 to 3 years after a new osteoporotic fracture. 

“The health care system is failing the more than 54 million people who either already have osteoporosis or are at high risk of the disease,” said Elizabeth Thompson, CEO of NOF. “The good news is that we have the tools to stem this crisis. Medicare pays for state-of-the-art bone density testing to identify those who are 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 percent and cut repeat fractures by about half. And new models of coordinated care for patients post-fracture have proven to reduce rates of fractures and lower costs.”   

The NOF made the following recommendations based on the report that include:

• Medicare and other payers should incentivize and promote evidence-based care management and coordination for those who have suffered a bone fracture and are at risk for another.   
• Medicare should eliminate cuts to Medicare payment rates for osteoporosis screening.
• Medicare and other payers should establish, adopt and incentivize appropriate quality measures for both optimal screening and treatment of osteoporosis and bone fractures.
• A national education campaign should be launched to raise awareness about bone health and the importance of appropriate prevention, screening and treatment.

The Milliman findings are based on their review of an extensive database of Medicare fee-for-service claims paid in 2015. While Milliman’s analysis did not include a review of Medicare Part D claims, a 2019 peer-reviewed article found [i]that, “while Medicare covers effective screening and treatments, the percentage of patients aged 50 and older, with either commercial or Medicare supplemental health insurance, who received a registered therapy for osteoporosis within twelve months of a hip fracture has declined in the U.S. from 40% in 2002 to 21% in 2011.”

Bruce Pyenson, a Milliman co-author, said, “I would like to compliment the National Osteoporosis Foundation for having the vision to support our real-world data approach to the burden of osteoporosis. While we all hope for break-through therapies for chronic conditions, we have many tools now to use better osteoporosis management, and the real-world data highlights the need in the Medicare population.”

For a full copy of the report, please visit NOF’s National Bone Health Policy Institute website under resources.