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Analysis

Osteoporosis, Bone Fractures Cost Medicare $6.3B

By Jack O'Brien  
   September 11, 2019

The study predicts that the total cost of care associated with osteoporotic fractures will be $95 billion in 2040.

The additional costs of osteoporosis and subsequent bone fractures topped $6.3 billion, according to a Milliman study commissioned by the National Osteoporosis Foundation (NOF) Wednesday morning. 

According to the report, 2 million Medicare recipients suffered 2.3 million fractures in 2015, however, only 9% of beneficiaries were screened for osteoporosis within six months of sustaining their initial fracture.  

The study's findings point to both the sizable financial impact of osteoporotic fractures as well as the lack of robust utilization for preventative measures. 

In the 12-month period after sustaining an osteoporotic fracture, the direct medical cost exceeded $21,800 per Medicare beneficiary, more than twice the costs incurred in the 12-month period prior to the injury.

Perhaps most notably, while more than 40% of Medicare beneficiaries who suffered an osteoporotic fracture were hospitalized within a week, nearly 20% died within a year of suffering an additional fracture.

Related: New Labels Coming for Osteoporosis Drugs

In 2018, the total annual expense of providing care associated with osteoporosis fractures was $57 billion and is expected to rise to $95 billion in 2040, according to NOF.  

Elizabeth Thompson, CEO of NOF, said the healthcare system has failed millions who suffer from osteoporosis but added that there are proven methods to curb its impact.

"Medicare pays for state-of-the-art bone density testing to identify those who are at risk of bone fractures, allowing for early and effective preventive steps and interventions.  Medicare also pays for FDA-approved drug treatments for osteoporosis that can help reduce spine and hip fractures by up to 70 percent and cut repeat fractures by about half," Thompson said in a statement. "And new models of coordinated care for patients post-fracture have proven to reduce rates of fractures and lower costs."  

The NOF report indicates that a 15% to 20% reduction in "secondary" fractures, those that occur after the initial injury, could have reduced Medicare spending by between $310 million to $1.2 billion in 2015. 

The report also offered recommendations for Medicare, including incentives for evidence-based care management and coordination for those with an osteoporotic fracture, eliminating cuts to payment rates for screenings, and establishing quality measures for screening and treatment options.

Related: More People Are Living With, Not Dying From, Hip Fractures

Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

Only 9% of beneficiaries were screened for osteoporosis within six months of sustaining their initial fracture.

The report indicates that a 15% to 20% reduction in "secondary" fractures could have reduced Medicare spending by between $310 million to $1.2 billion in 2015.

Nearly 20% of Medicare beneficiaries died within a year of suffering an additional fracture.

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