Osteoporosis a growing threat: more DXA scans needed, bone health expert says

Increased Medicare reimbursement for bone scans is a neglected, long-term solution to the growing health burden of osteoporosis in the United States, one expert says.

Fully one in two women and as many as 1 in 4 men aged 50 and older will break a bone in their remaining lifetime, wrote Andrea Singer, M.D., FACP, in an opinion piece published Sunday in The Hill. These breaks often lead to disability and death, yet fewer than 12% of women on Medicare receive central dual-energy X-ray absorptiometry (DXA), a simple bone scan that can detect weakened bones and help clinicians intervene before a fracture occurs, she reported.

“In recent years, misaligned payment policy has increasingly restricted access to this essential screening, posing serious health risks to older Americans,” wrote Singer, who heads the Division of Women’s Primary Care and directs the Bone Densitometry and the Fracture Liaison Service at MedStar Georgetown University Hospital, Washington, D.C.

Medicare’s reimbursement rates for DXA scans have fallen by more than 70% since 2007, making the scans economically unfeasible for many clinicians. In fact, more than 10,000 U.S. healthcare providers have stopped offering DXA testing between 2008 and 2019 due to a decrease in reimbursement rates — a 44% decrease in scans overall, Singer wrote.

The pandemic has further exacerbated the problem, with 33% of providers saying that they’d postponed DXA exams during widespread shutdowns. Singer reported. 

This year, Congress should reconsider the Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act (H.R. 3517/S. 1943) to ensure access to potentially lifesaving osteoporosis screening, according to Singer. The bill, from 2018, was reintroduced in Congress in May, and would restore the minimum Medicare reimbursement for DXA testing to 70% of the original level, she explained.

“This is a growing problem with long-lasting consequences that has been compounded by the pandemic, and any further cuts to screening could prove fatal for many older Americans,” Singer concluded.