This op-ed originally appeared in The Hill on October 20, 2022.
For more information on how to raise awareness about the importance of DXA scans for all women, visit our YesYouScan page.
America has a bone health crisis. More than 50 million Americans are at risk of developing osteoporosis, and 10 million already have the condition. A full 80 percent of those individuals are women. In fact, one in five women over the age of 50 will develop the disease in her lifetime.
But despite its prevalence, osteoporosis is known as a “silent disease.” The nickname comes from the fact that people often have increasingly brittle bones that are prone to breakage without knowing or feeling that their bone density is decreasing. But the name is also apt because too little is still known about osteoporosis, how to prevent or delay its onset, and what to do once 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 are made up of living tissue, which is constantly being broken down and replaced. When the body loses old bone tissue faster than it creates new tissue, osteoporosis occurs. At this stage, the remaining bones can become so weak and brittle that even simple movements such as stretching, twisting, bending to the floor, coughing, bumping into something, or a minor fall can cause a bone fracture.
These broken bones – usually of 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 about 2.1 million osteoporotic fractures in 2016. And last month, researchers in Hong Kong found that hip fractures will nearly double around the world by 2050.
Women in particular are at risk for osteoporosis and often experience rapid bone loss, especially in the five to seven years after menopause, as their estrogen levels drop. In this short time frame alone, women can lose up to 20 percent of their bone density. Ultimately, 50 percent of women are likely to break a bone from the disease.
Hip fractures are particularly damaging. Women’s risk of breaking a hip from osteoporosis equals risk of breast, uterine and ovarian cancer combined. Yes, you read that right.
And that’s not all. Every year, more women die from hip fracture complications than from breast cancer. Of women over 50 who break a hip, 25 percent will die in the year following their injury, while 50 percent will never be able to walk independently again and 20 percent will have to move permanently to a nursing home. Taken together, those osteoporotic fractures cause more hospitalizations and higher healthcare costs than heart attack, stroke, or breast cancer in women age 55 and older.
The economic burden of this disease is also significant. The total annual health care costs for Medicare beneficiaries suffering from osteoporotic fractures were estimated to be $57 billion in 2018. That number includes both direct medical costs and indirect social costs arising from lost productivity and informal caregiving. These costs are expected to rise to more than $95 billion by 2040. With America’s aging population, this should alarm everyone.
But it doesn’t have to be that way. Controlling osteoporosis is well within our capabilities. We know that diets 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 essential. Weight-bearing and muscle-strengthening exercises are also critical. In fact, strength training can both moderate and slow down bone loss and make bones stronger.
But those are not our only tools. Preventive bone density scans, or dual-energy X-ray absorptiometry scans (DXA for short), are easy, painless, and inexpensive. They are also incredibly effective. DXA scans can predict broken bones better than cholesterol tests can predict heart attacks or taking someone’s blood pressure can predict a stroke. It turns out that Medicare beneficiaries who had a DXA bone density test had a 35 percent reduction in hip fractures and a 22 percent reduction in fragility fractures.
The problem is that too few people at risk for osteoporosis get these scans. In 2007, Medicare lowered reimbursement for scans done in a doctor’s office, and since then the number of patients receiving them has fallen dramatically. Reduced access to DXA scans that are readily available in a doctor’s office since 2008 has resulted in 7 million fewer women having their bone density tested, according to the Fracture Prevention Coalition. This number will only increase unless something is done about it.
These alarming statistics are why it is absolutely critical for Congress to pass HR 3517, the 2021 Increased Access to Osteoporosis Testing for Medicare Beneficiaries Act, without delay. This bill 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. More testing will also lower our nation’s astronomical health care costs by reducing the number of preventable osteoporotic fractures.
The millions of people, and women in particular, for whom osteoporosis poses such a serious risk, can no longer wait for this bill. Their health, and often their lives, depends on it.