Screening and treating at-risk patients can prevent fractures and reduce the morbidity associated with osteoporosis. Over the last few years, rates of osteoporosis screening via DXA testing have steadily declined in the US. The initial decline in 2006 was associated with reductions in the DXA reimbursement rates by Medicare. Fewer DXA scans were performed in 2007 and 2008 than the number projected using Commercial and Medicare Supplemental Insurance data from 2000 to 2006,1 and similar declines were observed in Medicare Fee-for-Service population.2 More recently, DXA examination rates were studied in women aged 50 years to 64 years, and the authors found reductions in the number of DXA scans performed between 2006 and 2012 (-35 DXAs per 1,000 patient years) in this younger population, with the most significant reduction (-33%) in the 50- to 54-year age group.3
The reduction in overall DXA screening is also affecting the high-risk fracture patient population. The use of DXA postfracture is low. In one Midwestern county hospital, only 10% of hip fracture patients had a DXA ordered upon hospital discharge.4 Only 10% of Medicare beneficiaries who sustained a major osteoporotic fracture received postfracture DXA testing,5. Four well-established Midwestern health care systems reported less than one-quarter of patients who had a hip fracture had bone density testing before or after their fracture.6 This data was corroborated by national Healthcare Effectiveness Data and Information Set (HEDIS) measures, demonstrating that less than one-third of people postfracture have received testing or treatment.7
- 1. O'Malley CD, Johnston SS, Lenhart G, et al.: Trends in dual-energy X-ray absorptiometry in the United States, 2000–2009. J Clin Densitom 2011 Apr-Jun;14(2):100-107. doi: 10.1016/j.jocd.2011.03.003.
- 2. Zhang J, Delzell E, Zhao H, et al.: Central DXA utilization shifts from office-based to hospital-based settings among medicare beneficiaries in the wake of reimbursement changes. J Bone Miner Res 2012 Apr;27(4):858-864. doi: 10.1002/jbmr.1534.
- 3. Overman RA, Farley JF, Curtis JR, et al.: DXA utilization between 2006 and 2012 in commercially insured younger postmenopausal women. J Clin Densitom 2015 Apr-Jun;18(2):145-149. doi: 10.1016/j.jocd.2015.01.005. Epub 2015 Feb 18.
- 4. Antonelli M, Einstadter D, Magrey M.: Screening and treatment of osteoporosis after hip fracture: Comparison of sex and race. J Clinic Densitometry 2014;17(4):479-483. doi: 10.1016/j.jocd.2014.01.009. PMID: 24657109.
- 5. Liu SK, Munson JC, Bell JE, et al.: Quality of osteoporosis care among older medicare fragility fracture patients 2006–2010. J Am Geriatr Soc 2013 Nov;61(11):1855-1862. Published online 2013 Oct 28. doi: 10.1111/jgs.12507.
- 6. Harrington JT, Broy SB, Derosa AM, et al.: Hip fracture patients are not treated for osteoporosis: A call to action. Arthritis Rheum 2002 Dec 15;47(6):651-654.
- 7. National Committee on Quality Assurance: The state of health care quality 2014. 2014:90-91. Available at: http://www.ncqa.org/ReportCards/HealthPlans/StateofHealthCareQuality.aspx. Accessed August 2015.