Resolution: F-20-7: CALL FOR SUPPORT OF INCREASED ACCESS TO BONE MASS DENSITY SCANS

[Valerie Lile]

1  WHEREAS, 54 million people have low bone density or osteoporosis that will result in two
2  million osteoporotic fractures each year affecting one in two women and one in four men over
3  the age of 50¹; and
4  WHEREAS, fractures due to osteoporosis can have an impact on a patient’s activity and
5  function by decreasing daily activities such as walking, climbing stairs, or getting up from the
6  toilet; these physical restrictions can lead to muscle loss, and further avoidance of physical
7  activity which further increases the potential for subsequent fractures²; and
8  WHEREAS, possibly 80 % of individuals with a fracture caused by undiagnosed osteoporosis
9  are not identified and treated which leads to an 86% increase in the incidence of secondary
10  fracture in the years following the primary fracture^3,4; and
11  WHEREAS, the 1-year mortality rate of women and men over 65 who suffer a hip fracture is
12  30% and 42%, respectively⁵; and
13  WHEREAS, osteoporotic fractures are estimated to occur every 3 seconds costing the United
14  States healthcare system 20 billion USD per year, while individuals are expected to incur
15  significant personal costs especially in the year following the incident ^6,7
16  WHEREAS, early and effective medical screening for osteoporosis can reduce both the long-
17  term economic burden of disability in the current aging population and morbidity of patients with
18  osteoporosis ^4,7; and
19  WHEREAS, bone mineral density (BMD) tests can determine risk for fractures by identifying
20  osteoporosis and measuring the response to osteoporosis treatment using dual-energy x-ray
21  absorptiometry (DEXA) which is the gold standard for diagnosing and treating osteoporosis ^8,9,10;
22  and
23  WHEREAS, DEXA is a quick and painless test similar to an x-ray with much less exposure to
24  radiation; furthermore, it is more powerful at predicting fractures than cholesterol and blood
25  pressure are at predicting risk of myocardial infarction and stroke, respectively ^8,9,10; and
26  WHEREAS, Medicare began DEXA reimbursement cuts in 2007 as a result of the Federal
27  Deficit Reduction Act of 2005 and 2006¹¹ resulting in payment cuts that have exceeded 75% for
28  in-office DEXA screening^11,12; and
29  WHEREAS, Medicare DEXA reimbursement cuts since 2007 have resulted in 1/3 of DEXA
30  office providers discontinuing testing¹³; and,
31  WHEREAS, a study from 2011 found that the payment cuts reduced beneficiary access and tests
32  under-utilized by elderly female Medicare beneficiaries despite the irrefutable association with
1  fracture prevention, two years later than the 20-year trend of declining hip fractures stopped^13,14;
2  and,
3  WHEREAS, federal Legislation has been presented in 2019 to support increased access to bone
4  mass measurement and establishing a minimum payment amount.
5  WHEREAS, increasing the amount of DEXA payment to a proposed increased minimum may
6  encourage more bone density scans, thus reducing morbidity and the cost associated with
7  osteoporotic fractures; now, therefore, be it
8  RESOLVED, that the Student Osteopathic Medical Association (SOMA) supports legislative
9  efforts to increase access to bone mass measurement by establishing an equitable minimum
10  payment for the testing.
11  RESOLVED, that the Student Osteopathic Medical Association (SOMA) advocate to the
12  American Osteopathic Association (AOA) for support of legislative efforts to increase access to
13  bone mass measurement by establishing an equitable minimum payment for the testing.

References

1. National Osteoporosis Foundation. (2019, June 26). General Facts Bone Health Basics: Getting the Facts. https://www.nof.org/preventing-fractures/general-facts
2. Kerr, C., Bottomley, C., Shingler, S., Giangregorio, L., de Freitas, H. M., Patel, C., Randall, S., & Gold, D. T. (2017). The importance of physical function to people with osteoporosis. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 28(5), 1597–1607. https://doi.org/10.1007/s00198-017-3911-9
3. Kanis, J. A., Johnell, O., De Laet, C., Johansson, H., Oden, A., Delmas, P., Eisman, J., Fujiwara, S., Garnero, P., Kroger, H., McCloskey, E. V., Mellstrom, D., Melton, L. J., Pols, H., Reeve, J., Silman, A., & Tenenhouse, A. (2004). A meta-analysis of previous fracture and subsequent fracture risk. Bone, 35(2), 375– 382. https://doi.org/10.1016/j.bone.2004.03.024
4. Nguyen, T. V., Center, J. R., & Eisman, J. A. (2004). Osteoporosis: underrated, underdiagnosed and undertreated. The Medical Journal of Australia, 180(S5), S18–S22.
5. Tosteson, A. N., Gottlieb, D. J., Radley, D. C., Fisher, E. S., & Melton, L. J., 3rd (2007). Excess mortality following hip fracture: the role of underlying health status. Osteoporosis International: a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 18(11), 1463–1472. https://doi.org/10.1007/s00198-007-0429-6
6. Williams, S. A., Chastek, B., Sundquist, K., Barrera-Sierra, S., Leader, D., Jr, Weiss, R. J., Wang, Y., & Curtis, J. R. (2020). Economic burden of osteoporotic fractures in US managed care enrollees. The American Journal of Managed Care, 26(5), e142–e149. https://doi.org/10.37765/ajmc.2020.43156
7. Pike, C. T., Birnbaum, H. G., Schiller, M., Swallow, E., Burge, R. T., & Edgell,
8. T. (2011). Prevalence and costs of osteoporotic patients with subsequent non- vertebral fractures in the US. Osteoporosis International: a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 22(10), 2611–2621. https://doi.org/10.1007/s00198-010-1494-9
9. NIH Osteoporosis and Related Bone Diseases National Resource Center. (2018, October). Osteoporosis Overview. https://www.bones.nih.gov/healthinfo/bone/osteoporosis/overview
10. Miller, P. D., Zapalowski, C., Kulak, C. A., & Bilezikian, J. P. (1999). Bone densitometry: The best way to detect osteoporosis and to monitor therapy. The Journal of Clinical Endocrinology and Metabolism, 84(6), 1867–1871. https://doi.org/10.1210/jcem.84.6.5710
11. McAdam-Marx, C., Unni, S., Ye, X., Nelson, S., & Nickman, N. A. (2012). Effect of Medicare reimbursement reduction for imaging services on osteoporosis screening rates. Journal of the American Geriatrics Society, 60(3), 511–516. https://doi.org/10.1111/j.1532-5415.2011.03837.x
12. McAdam-Marx, C., Unni, S., Ye, X., Nelson, S., & Nickman, N. A. (2012). Effect of Medicare reimbursement reduction for imaging services on osteoporosis screening rates. Journal of the American Geriatrics Society, 60(3), 511–516. https://doi.org/10.1111/j.1532-5415.2011.03837.x
13. National Osteoporosis Foundation. (2016, August 12). CMS Proposes New Fee Schedules for 2017. https://www.nof.org/news/cms–proposes-new-fee-schedules- 2017/
14. Steven, P.M. (2019). Carrier 5% SAF and Inpatient 100% SAF. [Unpublished manuscript]. Braid-Forbes Health Research, LLC
15. King, A. B., & Fiorentino, D. M. (2011). Medicare payment cuts for osteoporosis testing reduced use despite tests’ benefit in reducing fractures. Health Affairs (Project Hope), 30(12), 2362–2370. https://doi.org/10.1377/hlthaff.2011.0233

Submitted by:

Alvio Dominguez, OMS II- Nova Southeastern University- Kiran C. Patel College of Osteopathic Medicine, Tampa Bay Regional
Kristina Fritz, OMS II- Nova Southeastern University- Kiran C. Patel College of Osteopathic Medicine, Tampa Bay Regional
Kristina Novotny, OMS II- Nova Southeastern University- Kiran C. Patel College of Osteopathic Medicine, Tampa Bay Regional
Lucia Soca, OMS II- Nova Southeastern University- Kiran C. Patel College of Osteopathic Medicine, Tampa Bay Regional

Action Taken: [Leave Blank. Will be Approved by the House of Delegates or Not Approved.]
Date: [Leave Blank. Date submitted to National Vice President and the National Office.]
Effective Time Period: Ongoing

[Author]

Posts