This comment originally appeared in The Hill on October 20, 2022.
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America has a bone health crisis. More than 50 million Americans are at risk of developing osteoporosis, and 10 million already have the condition. Fully 80 percent of these individuals are women. In fact, one in five women over the age of 50 will develop the disease in their lifetime.
However, despite its prevalence, osteoporosis is known as the “silent disease”. The nickname comes from the fact that people often have increasingly brittle bones prone to fractures, without knowing or feeling that their bone density is decreasing. But the name is also appropriate because there is still too little awareness of osteoporosis, how to prevent or delay its onset, and what to do once it is diagnosed.
But on this World Osteoporosis Day, we can change that. And we must try because the consequences of osteoporosis-related fractures are serious for too many women, their families, and our nation as a whole.
Our bones consist of living tissue that is constantly being broken down and replaced. When the body loses old bone tissue faster than it regenerates new tissue, then osteoporosis begins. At this stage, the remaining bones can become so weak and fragile that even simple movements such as stretching, turning, bending to the floor, coughing, bumping into something, or a small fall can cause a broken bone.
These broken bones – most commonly the hip and spine – are dangerously common. According to a 2021 report commissioned by the Bone Health and Osteoporosis Foundation, about 1.8 million Medicare beneficiaries suffered approximately 2.1 million osteoporosis-related fractures in 2016. And just last month, researchers in Hong Kong found that fractures hook almost double worldwide by 2050.
Women are especially at risk of osteoporosis and often experience rapid bone loss, especially in the five to seven years after menopause, as their estrogen levels drop. Women can even lose up to 20 percent of their bone density in just this short time frame. Ultimately, 50 percent of women are likely to break a bone due to the disease.
Hip fractures are especially dangerous. A woman’s risk of hip fracture due to osteoporosis is equal to the risk of breast, uterine and ovarian cancer combined. Yes, you read that right.
And that’s not all. Every year, more women die from complications after a hip fracture than from breast cancer. Among women over 50 who break a hip, 25 percent die within a year of the injury, while 50 percent never walk on their own again, and 20 percent must move permanently to a nursing home. Overall, these osteoporotic fractures cause more hospitalizations and higher health care costs than heart attack, stroke, or breast cancer in women over 55.
The economic burden of this disease is also significant. The total annual cost of providing care for Medicare beneficiaries suffering from osteoporotic fractures was estimated at $57 billion in 2018. This number includes direct medical costs as well as indirect societal costs resulting from lost productivity and informal caregiving. These costs are expected to rise to more than $95 billion in 2040. With America’s aging population, this should be alarming.
But it doesn’t have to be this way. Managing osteoporosis is within our capabilities. We know that a diet rich in calcium and vitamin D can help keep bones strong. Avoiding caffeine, excess salt, alcohol and smoking – all of which can contribute to bone loss or increase the risk of fractures – is key. Weight bearing and muscle strengthening exercises are also critical. In fact, strength training can actually mitigate and delay bone loss as well as strengthen bones.
But these are not our only tools. Preventive bone density examinations or dual-energy x-ray absorptiometric examinations (abbreviated DXA) are simple, painless and inexpensive. They are also incredibly effective. A DXA scan can predict broken bones better than a cholesterol test can predict a heart attack or a blood pressure measurement can predict a stroke. It turns out that Medicare beneficiaries who have a DXA bone density test have 35 percent fewer hip fractures and 22 percent fewer fragility fractures.
The problem is that too few people who are at risk of osteoporosis go for these tests. In 2007, Medicare reduced reimbursement for in-office tests, and since then there has been a drastic drop in the number of patients receiving them. According to the Fracture Prevention Coalition, reduced access to DXA scans performed virtually in a doctor’s office since 2008 means 7 million fewer women have been tested for bone density. This number will only increase if something is not done.
These alarming statistics are why it is absolutely critical that Congress pass HR 3517, the Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2021., Without delay. This legislation will increase access to DXA scans for Medicare beneficiaries by restoring Medicare funding for the procedure. When patients are diagnosed and treated more quickly and accurately, they will be better equipped to take care of themselves and their long-term health. Increased testing will also reduce our nation’s astronomical health care costs by reducing the number of avoidable osteoporosis fractures.
Millions of people, especially women, for whom osteoporosis is such a serious risk, can no longer wait for this bill. Their health, and often their life, depends on it.