.jpg)
Win an iPod
On-Site Osteoporosis Screening and Treatment:
| Author: Leigh Gott; Revised by Tony Cappasso |
| Article Date: 4/19/2008 |
Better Healthcare for Patients, Enhanced Revenue for the Physician
Osteoporosis is a systemic bone disease characterized by low bone mass and deterioration of bone tissue. Left untreated, the disease can progress and substantially increase bone fragility with a corresponding increase in risk of bone fracture.
Until a few decades ago, the first indication of osteoporosis in an older woman very likely was a bone fracture. Today, based on advances in technology and healthcare practices, symptoms of the disease can be recognized – and treated early – across the entire patient population. Physicians in office practice are in the forefront of bringing these advances in diagnosis and treatment to patients of both genders.
Measurement of a patient’s bone mass is the best way to diagnose osteoporosis. Dual x-ray absorptiometry (DXA) scanning has been validated for this measurement. DXA measures bone mineral density (BMD) and can aid clinicians in:
BMD has become a primary indicator of overall patient health and many physicians have incorporated on-site DXA screening into their primary care practices. After evaluating a patient’s history and performing a physical exam and risk factor assessment, physicians determine whether BMD testing is appropriate and use the measured values to make an immediate diagnosis.
On-site BMD capability has a positive impact on patients by raising the level of healthcare quality. Immediate, on-site diagnosis leads to faster time to treatment while emphasizing patient convenience and comfort. For the physician in office practice, adding BMD scanning to the suite of on-site services can provide the financial incentives that help to offset the burden of rising practice expenses. For example:
The financial incentives for BMD reflect both actual reimbursements as well as the costs involved with staff time.
Although Medicare reimbursements vary state by state, the agency generally allows reimbursement for a single BMD test every two years. It averages $82, depending on physician ownership of the scanning technology and the specific use of CPT codes. Medicare may allow for more frequent BMD screenings subject to medical necessity. The International Society for Clinical Densitometry (ISCD) lists guidelines for reimbursements. Visit their website, www. iscd.org for more information.
While any bone can be affected, fractures of the hip are of special concern.1 Hip fracture usually requires hospitalization and surgery. The results can be devastating to a patient’s lifestyle, including the ability to walk unassisted and live independently. Hip fractures may also cause prolonged or permanent disability, or even death. Evidence of disease prevalence can be charted for both sexes. (See Table 1.)
Table 1: Projected Prevalence of Osteoporosis and/or Low Bone Mass of the Hip in U.S. Women and Men ≥ 50 Years Old
Source: America’s Bone Health, National Osteoporosis Foundation, 2002
Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.
The diagnosis of osteoporosis is not based on the demonstration of hip or spinal fracture, which is a complication or clinical expression of the disease, but on parameters capable of reliably predicting the risk of fracture.2
According to the National Osteoporosis Foundation (NOF), the disease is a major health threat. As the population ages, the condition is reaching epidemic proportions. (See Table 2.) Each year, osteoporosis is responsible for more than 700,000 vertebral fractures and more than 300,000 hip fractures, with direct costs exceeding $18 billion per year.
According to the U.S. Surgeon General, the incidence of osteoporosis and low bone mass is expected to climb from 43.7 million in 2002 to 61.1 million by the year 2020, a 39 percent increase.
Women older than age 50 have a 50 percent chance of sustaining an osteoporotic fracture in their lifetime. Approximately one in four men older than 50 years of age will experience an osteoporosis-related fracture during his lifetime.3
Table 2: Elderly and Upper Middle-Age Population US, 1970 - 2050
Source: U.S. Census Bureau
Although osteoporosis has been diagnosed across virtually all patient groups, specific populations are at greater risk. They include:
Osteoporosis is a preventable disease, not an inevitable part of the aging process. Unfortunately, many patients are asymptomatic until bone loss is advanced and one or more fractures have occurred. Thus physician office screening for the illness takes on added importance.
Patients who have a hip fracture have up to 20 percent mortality in the first year following the fracture. Fewer than 50 percent of patients are able to regain their pre-fracture levels of mobility and independence. Prevention of osteoporotic fractures through early screening, diagnosis, intervention and monitoring is thus vitally important.3
The impact of osteoporosis on patients, their families and their healthcare providers is tremendous. Experts estimate that 180,000 seniors will be forced into nursing homes, 800,000 will receive treatment in emergency departments and 300,000 will be hospitalized annually.
Osteoporosis is preventable when diagnosed in pre-symptomatic early stages with the help of DXA technology. Early treatment can prevent additional bone loss and keep patients active and healthy.
As a physician, the challenge of monitoring your patients’ bone health can also be an opportunity. With an aging patient population, BMD screening will help improve physicians’ standard of care while providing additional revenue.
1. National Osteoporosis Foundation. www.nof.org.
2. Rizzoli R. The Measurement of Bone Mass. Postgraduate Training course in Reproductive Health/Chronic Disease. WHO Collaborating Center for the Prevention of Osteoporosis, Department of Internal Medicine, University Hospital, Geneva, Switzerland. www.gfmer.ch/Endo/Course2003/Bone_mass.htm
3. Lambing CL. Osteoporosis • Reducing Fracture Risk. CME Bulletin, American Academy of Family Physicians. Vol. 4, No. 5, October 2005.
4. International Society for Clinical Densitometry. www.iscd.org
Osteoporosis is a systemic bone disease characterized by low bone mass and deterioration of bone tissue. Left untreated, the disease can progress and substantially increase bone fragility with a corresponding increase in risk of bone fracture.
Until a few decades ago, the first indication of osteoporosis in an older woman very likely was a bone fracture. Today, based on advances in technology and healthcare practices, symptoms of the disease can be recognized – and treated early – across the entire patient population. Physicians in office practice are in the forefront of bringing these advances in diagnosis and treatment to patients of both genders.
Measurement of a patient’s bone mass is the best way to diagnose osteoporosis. Dual x-ray absorptiometry (DXA) scanning has been validated for this measurement. DXA measures bone mineral density (BMD) and can aid clinicians in:
- Detecting osteoporosis before a fracture occurs
- Predicting the probability of a future fracture
- Measuring the rate of bone loss in the patient
- Monitoring the effects of osteoporosis treatment
BMD has become a primary indicator of overall patient health and many physicians have incorporated on-site DXA screening into their primary care practices. After evaluating a patient’s history and performing a physical exam and risk factor assessment, physicians determine whether BMD testing is appropriate and use the measured values to make an immediate diagnosis.
On-site BMD capability has a positive impact on patients by raising the level of healthcare quality. Immediate, on-site diagnosis leads to faster time to treatment while emphasizing patient convenience and comfort. For the physician in office practice, adding BMD scanning to the suite of on-site services can provide the financial incentives that help to offset the burden of rising practice expenses. For example:
- BMD has a higher reimbursement rate than most ancillary services (See Table 3.)
- BMD reimbursement history shows a 10 % increase in the allowable amount over the past 5 years
The financial incentives for BMD reflect both actual reimbursements as well as the costs involved with staff time.
Although Medicare reimbursements vary state by state, the agency generally allows reimbursement for a single BMD test every two years. It averages $82, depending on physician ownership of the scanning technology and the specific use of CPT codes. Medicare may allow for more frequent BMD screenings subject to medical necessity. The International Society for Clinical Densitometry (ISCD) lists guidelines for reimbursements. Visit their website, www. iscd.org for more information.
While any bone can be affected, fractures of the hip are of special concern.1 Hip fracture usually requires hospitalization and surgery. The results can be devastating to a patient’s lifestyle, including the ability to walk unassisted and live independently. Hip fractures may also cause prolonged or permanent disability, or even death. Evidence of disease prevalence can be charted for both sexes. (See Table 1.)
Table 1: Projected Prevalence of Osteoporosis and/or Low Bone Mass of the Hip in U.S. Women and Men ≥ 50 Years Old
| 2002 | 2010 | 2020 | ||
| Women | Osteoporosis | 7,800,000 | 9,100,000 | 10,500,000 |
| Low Bone Mass | 21,800,000 | 26,000,000 | 30,400,000 | |
| Men | Osteoporosis | 2,300,000 | 2,800,000 | 3,300,000 |
| Low Bone Mass | 11,800,000 | 14,400,000 | 17,100,000 | |
| Both Sexes | Osteoporosis | 10,100,000 | 12,000,000 | 13,900,000 |
| Low Bone Mass | 33,600,000 | 40,400,000 | 47,500,000 | |
| Either | 43,600,000 | 52,400,000 | 61,400,000 | |
Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.
The diagnosis of osteoporosis is not based on the demonstration of hip or spinal fracture, which is a complication or clinical expression of the disease, but on parameters capable of reliably predicting the risk of fracture.2
According to the National Osteoporosis Foundation (NOF), the disease is a major health threat. As the population ages, the condition is reaching epidemic proportions. (See Table 2.) Each year, osteoporosis is responsible for more than 700,000 vertebral fractures and more than 300,000 hip fractures, with direct costs exceeding $18 billion per year.
According to the U.S. Surgeon General, the incidence of osteoporosis and low bone mass is expected to climb from 43.7 million in 2002 to 61.1 million by the year 2020, a 39 percent increase.
Women older than age 50 have a 50 percent chance of sustaining an osteoporotic fracture in their lifetime. Approximately one in four men older than 50 years of age will experience an osteoporosis-related fracture during his lifetime.3
Table 2: Elderly and Upper Middle-Age Population US, 1970 - 2050
Source: U.S. Census Bureau
Although osteoporosis has been diagnosed across virtually all patient groups, specific populations are at greater risk. They include:
- All women aged 65 and older, regardless of risk factors
- Younger postmenopausal women with one or more risk factors other than being white, postmenopausal and female
- Men aged 70 years and older
- Adults with a fragility fracture
- Adults with a disease or condition associated with low bone mass or bone loss 1, 4
Osteoporosis is a preventable disease, not an inevitable part of the aging process. Unfortunately, many patients are asymptomatic until bone loss is advanced and one or more fractures have occurred. Thus physician office screening for the illness takes on added importance.
Patients who have a hip fracture have up to 20 percent mortality in the first year following the fracture. Fewer than 50 percent of patients are able to regain their pre-fracture levels of mobility and independence. Prevention of osteoporotic fractures through early screening, diagnosis, intervention and monitoring is thus vitally important.3
The impact of osteoporosis on patients, their families and their healthcare providers is tremendous. Experts estimate that 180,000 seniors will be forced into nursing homes, 800,000 will receive treatment in emergency departments and 300,000 will be hospitalized annually.
Osteoporosis is preventable when diagnosed in pre-symptomatic early stages with the help of DXA technology. Early treatment can prevent additional bone loss and keep patients active and healthy.
As a physician, the challenge of monitoring your patients’ bone health can also be an opportunity. With an aging patient population, BMD screening will help improve physicians’ standard of care while providing additional revenue.
1. National Osteoporosis Foundation. www.nof.org.
2. Rizzoli R. The Measurement of Bone Mass. Postgraduate Training course in Reproductive Health/Chronic Disease. WHO Collaborating Center for the Prevention of Osteoporosis, Department of Internal Medicine, University Hospital, Geneva, Switzerland. www.gfmer.ch/Endo/Course2003/Bone_mass.htm
3. Lambing CL. Osteoporosis • Reducing Fracture Risk. CME Bulletin, American Academy of Family Physicians. Vol. 4, No. 5, October 2005.
4. International Society for Clinical Densitometry. www.iscd.org