Mother and daughter

Osteoporosis: State Laws

Updated June 2008

Osteoporosis is characterized by low bone mass and the deteroriation of bone tissues, which increase the risk of bone fractures. The disease primarily affects older women because of the significant physical changes that affect bone health during and following menopause. Osteoporosis is often called the "silent disease" because bone loss occurs without symptoms and may not be detected until a fracture occurs. Bone mineral density tests can be performed to identify osteoporosis and determine risk for fractures before they occur. Osteoporosis treatment focuses on proper nutrition, exercise and fall prevention. In addition, medications may slow or stop bone loss, increase bone density, and reduce fracture risk. Building strong bones in childhood and adolescence can help prevent osteoporosis later in life. Almost 90 percent of bone mass is acquired by age 18 in women and by age 20 in men.

In the U.S., 10 million individuals, 80 percent of whom are women, are estimated to have osteoporosis and almost 34 million more are estimated to have low bone mass, placing them at increased risk for the disease. Half of women over age 50 will have an osteoporosis-related fracutre in their life. Fractures due to osteoporosis are most likely in the hip, spine and wrist, but any bone can be affected. In 2005, osteoporosis was responsible for more than 2 million fractures, costing an estimated $19 billion in direct care. By 2025, osteoporosis-related fractures are expected to cost approximately $25.3 billion. Approximately 75 percent of health care costs of osteoporosis for women over the age of 45 are paid for by Medicare and Medicaid. Each year, 140,000 nursing home admissions are the direct result of a hip fracture.

Federal and state legislation has been introduced in an effort to increase funding for medical research on osteoporosis, expand bone health and osteoporosis education programs, and improve access and reimbursement for tests to diagnose the disease.

At least thirty-five states and Puerto Rico have enacted laws relating to osteoporosis, the majority of which establish statewide education, public awareness and prevention programs. At least fourteen states--California, Florida, Georgia, Illinois, Kansas, Kentucky, Louisiana, Maryland, Missouri, New York, North Carolina, Oklahoma, Tennessee and Texas--mandate insurance coverage for osteoporosis-related diagnostic and treatment services, including technologies approved by the Federal Drug Administration (FDA) and bone density measurement.

First Letter of State A C D F G H I K L M N O R T U V W

State	Summary of Statutes
Alabama	Ala. Code § 22-13A-1 et seq. (1995) creates the Osteoporosis Prevention and Treatment Education Act to foster a multigenerational statewide program to promote public awareness and knowledge about the causes of osteoporosis, risk factors, the value of prevention and early detection, and the options available for treatment.
American Samoa
Alaska
Arizona	Arizona SB. 1248 (2006) Chapter No. 362 grants appropriation to the Department of Health Services for services related to osteoporosis. Appropriations will foster collaboration between county health departments, community health centers and private organizations with an interest in osteoporosis to create a statewide network for conducting osteoporosis screenings, with specific focus on rural and underserved areas.
Arkansas	Ark. Stat. Ann. § 20-15-1401 et seq. (1997) creates the Osteoporosis Prevention and Treatment Act and requires the department of health to coordinate with other agencies and organizations to establish, promote, and maintain an osteoporosis prevention and treatment education program. The purpose of the program is to raise public awareness, educate consumers, and educate and train health professionals and service providers.
California	Cal. Acts, Chap. No. 39 (2003) recognizes May 2003 as Osteoporosis Awareness Month. Encourages all people to honor their mothers by raising awareness of osteoporosis and encourages women to obtain fracture protection by managing osteoporosis and maintaining bone health. (A.C.R. 82) Cal. Acts, Chap. No. 73 (2002) recognizes May 2002 as Osteoporosis Awareness Month. Encourages all people in the state to become educated about their risk of developing osteoporosis, and the methods of diagnosis and treatment of the disease. (A.C.R. 173) Cal. Insurance Code § 10123.185 requires disability insurers to provide coverage for services related to the diagnosis, treatment, and appropriate management of osteoporosis. Services may include all Food and Drug Administration (FDA) approved technologies including bone mass measurement technologies as deemed medically appropriate. Cal. Health and Safety Code § 125700 et seq. (1999) creates the California Osteoporosis Prevention and Education Act to promote public awareness of the disease and to educate the public on the prevention and management of osteoporosis. Cal. Health and Safety Code § 1367.67 (1993) requires insurers to provide coverage for the diagnosis, treatment, and appropriate management of osteoporosis, which includes all technologies approved by the Federal Drug Administration (FDA) and bone mass measurement technologies as deemed medically appropriate.
Colorado
Connecticut	Conn. Acts, P.A. 99-9 (1999) creates the Osteoporosis Education and Awareness Advisory Council for the purposes of assessing the extent of osteoporosis, advocacy, policy, public and medical education. The council is charged with instituting a statewide media campaign on prevention, and preparing and distributing material to reach high-risk groups. The advisory council terminates two years from the date of its inception. (S.B. 1250) [Act expired in 2001] Conn. Acts, P.A. 96-245 (1996) establishes a task force to study the availability of resources devoted to the prevention and treatment of osteoporosis. (S.B. 57) [Act expired in 1996] Conn. Gen. Stat. Ann. § 20-631 concerns a collaborative drug therapy management agreement which allows pharmacists to work with physicians to manage drug therapy for osteoporosis.
Delaware	Del. Code Ann. tit. 16 § 30-3001 (1998) establishes the Osteoporosis Prevention and Education Initiative within the Department of Health and Social Services to promote and maintain an osteoporosis prevention and education initiative. The initiative raises public awareness about the causes and nature of osteoporosis, personal risk factors, and the value of prevention and early detection.
District of Columbia
Florida	Fla. Stat. § 381.87 (1996) creates the Osteoporosis Prevention and Education Program to promote public awareness of the causes of osteoporosis, options for prevention, the value of early detection, and possible treatments, including the benefits and risks of those treatments. Fla. Stat. § 627.6409, 627.6691, 641.31 (1996) requires insurers to provide coverage for the medically necessary diagnosis and treatment of osteoporosis for high-risk individuals, with some exceptions.
Georgia	Ga. Code Ann. § 31-15A-1 et seq. (1998) enacts the Bone Mass Measurement Coverage Act. The act requires insurance plans to offer coverage for scientifically proven bone mass measurement screenings for the prevention, diagnosis and treatment of osteoporosis. Ga. Code Ann. § 31-42.1 et seq. (1995) enacts the Osteoporosis Prevention and Treatment Education Act to create a multigenerational, statewide program to promote awareness and knowledge about osteoporosis, risk factors, prevention, detection and treatment options.
Guam
Hawaii
Idaho
Illinois	Ill. Ann. Stat. ch. 215, § 356z.6 amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, The Health Maintenance Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage for bone mass measurement and treatment of osteoporosis. Ill. Ann. Stat. ch. 320, § 25/3.15 amends the Senior Citizens and Disabled Persons Property Tax Relief and Pharmaceutical Assistance Act by adding coverage for any prescription drug used in the treatment of osteoporosis. Ill. Rev. Stat. ch. 20, § 2305/8.2 (1994) requires the Department of Public Health to establish, promote, and maintain an osteoporosis prevention and education program to promote public awareness of the causes of osteoporosis, options for prevention, the value of early detection and treatments.
Indiana	Ind. Code § 16-41-39.6 et seq. (1997) allows the Department of Health to establish an osteoporosis prevention and treatment program and establishes the osteoporosis education fund.
Iowa
Kansas	Kan. Stat. Ann. § 40-2, 166a (2001) requires insurers to provide coverage for services related to diagnosis, treatment and management of osteoporosis. This includes bone mass measurement when medically necessary for an individual. (S.B. 19)
Kentucky	Ky. Rev. Stat. § 211.635 (2006) establishes a multigenerational osteoporosis prevention and education program to promote public awareness of the disease. Awareness efforts are to focus on the causes of osteoporosis, options for prevention, the value of early detection and treatment, and increasing awareness of national clinical guidelines for health care providers. (S.B.202) Ky. Rev. Stat. § 304.17-3163, 304.17A-134, 304.18-0983, 304.32-1593, 304.1934 (1998) requires insurers to make available and offer coverage for bone density testing for women 35 years and older to obtain baseline data for the early detection of osteoporosis.
Louisiana	La. Rev. Stat. Ann. § 46:153.3 (amended in 2004) provides for duties and responsibilities of the Medicaid Pharmaceutical and Therapeutics Committee; requires that prior to a drug being authorized, it must have been reviewed by the Committee; provides that any pharmacopoeia developed by the Committee shall include but not be limited to drugs in specified therapeutic categories, including osteoporosis. La. Rev. Stat. Ann. § 22:215.16 (1999) requires insurers to include coverage for scientifically proven bone mass measurement tests for the diagnosis and treatment of osteoporosis.
Maine	Me. Rev. Stat. Ann. tit. 22 § 254-D (2005) The Maine Department of Health and Human Services will provide prescription drug benefits under the elderly low-cost drug program, including the coverage of drugs to treat osteoporosis.
Maryland	Md. Environmental Code Ann. § 13-1901 et seq. (2002) requires the Department of Health and Mental Hygiene to establish an Osteoporosis Prevention and Education Task Force. (H.B. 532) Md. Insurance Code Ann. § 15-823 (1997) requires coverage for reimbursement of bone mass measurement for individuals when the measurement is requested by a health care provider. The law requires insurance plans to provide specified coverage for individuals for a procedure used to identify bone mass or detect bone loss for the prevention, diagnosis and treatment of osteoporosis.
Massachusetts
Michigan	Mich. Pub. Acts, Act 336 (1998; appropriations bill; not codified) allocates $650,000 from the health education, promotion and research programs appropriation for the implementation of an osteoporosis prevention and treatment education program. (SB 908) Mich. Pub. Acts, Act 94 (1997; appropriations bill; not codified) requires the Department of Community Health to allocate $150,000 to implement an osteoporosis prevention and treatment education program.
Minnesota	Minn. Stat. § 144.121 (1996) permits the use of direct exposure x-ray film in radiographic absorptionmetry for the diagnosis and management of osteoporosis. (Chap. 203; SF 1908) Minn. Laws, Chap. 207 (Art. 6) (1995; appropriations bill; not codified) requires the Department of Health to report on the need for an osteoporosis prevention and treatment program and authorizes the department to apply for grants and gifts to establish a program. (SF 1110)
Mississippi	Miss. Code Ann. § 41-93-1 et seq. (1994) establishes the Osteoporosis Prevention and Treatment Education Act to create a statewide program to promote public awareness and knowledge about the causes of osteoporosis, personal risk factors, the value of prevention and early detection and the options available for treatment.
Missouri	Mo. Rev. Stat. § 192.640 et seq. (1995) authorizes the Department of Health to establish, promote and maintain an osteoporosis prevention and education program to promote public awareness of the causes of osteoporosis, options for prevention, the value of early detection and possible treatments. The law also authorizes the department to establish an Osteoporosis Advisory Council to be appointed by the health department director. Mo. Rev. Stat. § 376.1199 (2001) requires health benefit plans that provide OBGYN benefits to include coverage related to diagnosis, treatment and management of osteoporosis.
Montana
Nebraska
Nevada	Nev. Rev. Stat. § 236.065 (1997) requires the governor to proclaim annually that the week beginning with Mother's Day is Osteoporosis Prevention and Awareness Week in Nevada.
New Hampshire	N.H. Rev. Stat. § 126:I-1 et seq. (1997) requires the Department of Health and Human Services to establish, promote and maintain an osteoporosis prevention and education program. The program shall promote public awareness about the causes of osteoporosis options for prevention, and the value of early detection and possible treatments, including the benefits and risks of those treatments. The law also provides for the establishment of an advisory council.
New Jersey	N.J. Stat. § 26:2R-1 et seq. (1997) establishes an osteoporosis prevention and education program in the Department of Health and Senior Services. The purpose of the program is to promote public awareness about the causes of osteoporosis, options for prevention, the value of early detection and possible treatments. The law also creates the Interagency Council on Osteoporosis.
New Mexico
New York	N.Y. Public Health Law § 2705 et seq. (1998) establishes the Osteoporosis Prevention and Education Program to promote public awareness of the causes of osteoporosis, options for prevention, and the value of early detection and possible treatments. The program implements a public education and outreach campaign to promote osteoporosis prevention and a professional education program for health care providers and health-related community-based organizations. The law also creates an osteoporosis advisory council. (A.B. 11723) N.Y. Insurance Law § 3221, 4303, 4322 (2002) requires that certain health insurance contracts provide coverage for bone mineral density measurements or tests, and if contracts include prescription drug coverage, drugs and devices approved by the FDA. Additionally, the insurer or HMO must adopt standards which include the criteria of the federal Medicare program and the National Institutes of Health for the detection of osteoporosis, when determining coverage for bone mineral density measurements or tests. (S0 2014)
North Carolina	N.C. Gen. Stat. § 58-50-155 provides that bone mass measurement for the diagnosis and evaluation of osteoporosis be covered by the developed standard health plan. N.C. Gen. Stat. § 58-3-174 (1999) requires insurers to provide coverage for scientifically proven and approved bone mass measurement services for the diagnosis and evaluation of osteoporosis or low bone mass. N.C. Sess. Laws, Chap. 443 (1997; appropriations bill; not codified) creates the Osteoporosis Task Force to raise public awareness, obtain statistical research and develop an osteoporosis prevention plan.
North Dakota
Ohio	Ohio Rev. Code Ann. § 3.17, 3.24, 9.06, 101.23 (1997) provides appropriations for the Osteoporosis Awareness Program.
Oklahoma	Okla. Stat. tit. 63, § 1-260.1 et seq. (1999) establishes within the Department of Health an osteoporosis prevention and treatment education program. The law also creates the Interagency Council on Osteoporosis. Okla. Stat. tit. 36, § 6060.1 (1996) requires insurers to provide coverage for bone density testing for people whose medical histories indicate a high risk of osteoporosis when the test is requested by a primary care or referral physician.
Oregon
Pennsylvania	Pa. Cons. Stat. tit. 71 § 531-A et seq. (1998) creates an Osteoporosis Prevention and Education Program to raise public awareness of the causes and effects of osteoporosis, personal risk factors, prevention, early detection and options for diagnosis and treatment. Pennsylvania HB 815 (2005) appropriates $95,000 in state funds for osteoporosis prevention and education programs. Funds were available for the fiscal year July 2005 to June 2006.
Puerto Rico	Laws of Puerto Rico Ann. 1 § 5121 establishes the second week of May each year as "Osteoporosis Prevention and Control Week," aimed at engaging the community in osteoporosis prevention and control through community activities for the Puerto Rican people.
Rhode Island	R.I. Gen. Laws § 42-66.2-3 (2001) provides pharmaceutical assistance to the elderly for drugs approved for the treatment of osteoporosis. (H.B. 5527) R.I. Gen. Laws § 23-70-1 et seq. (1997) authorizes the use of existing resources to educate the public on the causes of osteoporosis, personal risk factors, publicize the value of early detection and prevention, and identify the most cost-effective options available for treatment. In addition, the law allows for the director of the Department of Health to appoint a task force to make recommendations.
South Carolina	S.C. Code Ann. § 44-125-10 et seq. (1997) establishes the Osteoporosis Prevention, Treatment, and Education Act and the Osteoporosis Education Fund for the purpose of promoting public awareness, prevention, and treatment of osteoporosis. The law requires the Department of Health and Environmental Control to administer the fund and to establish an osteoporosis prevention and treatment education program.
South Dakota
Tennessee	Tenn H.J.R. 1071 (2004) designates May 2004 as Tennessee Osteoporosis Prevention Month. Tenn. H.J.R. 433 (2003) names May 2003 Osteoporosis Prevention Month. Tenn. Pub. Acts, H Jt. Res. 101 (2001; not codified) designates the month of May 2001 as "Tennessee Osteoporosis Prevention Month." Tenn. Code Ann. § 56-7-2506 (1996) creates the Bone Mass Measurement Coverage Act. The law requires insurers to provide coverage to a qualified individual for scientifically proven bone mass measurement (bone density testing) for the diagnosis and treatment of osteoporosis. Tenn. Pub. Acts, H. Jt. Res. 431 (1996; not codified) continues a special joint committee for two more years to further study and make recommendations on women's health issues. The resolution notes that the committee must devised specific recommendations relative to women's health issues, including osteoporosis research in state educational facilities. Tenn. Code Ann. § 68-1-1501 et seq. (1995) creates the Osteoporosis Prevention and Treatment Education Act. The law establishes a statewide program to promote public awareness and knowledge about osteoporosis within the Department of Health. This law was modified in 2008 by Tenn. Pub. Acts, Chap. 668 which terminates the Interagency Council and Advisory Panel on Osteoporosis as of July 1, 2008 (SB 2498).
Texas	Tex. Insurance Code Ann. § 1361.001 et seq. (1995) requires insurers to provide coverage for medically accepted bone mass measurement for the detection of low bone mass and to determine the risk of osteoporosis and fractures associated with osteoporosis. Tex. Health and Safety Code Ann. § 90.001 et seq. (1995) establishes a program to promote public awareness of the benefits and value of early detection, prevention and appropriate treatment of osteoporosis. The law also provides for the appointment of an osteoporosis task force.
U.S. Virgin Islands
Utah
Vermont
Virginia	Va. Code § 32.1-11.3 (1995) requests the Department of Health, in cooperation with the Medical Society of Virginia, to initiate an osteoporosis prevention and education program to promote public knowledge of the causes, prevention and value of early detection of osteoporosis.
Washington	Wash. Rev. Code § 28B.20.462 et seq. (1990) establishes the Warren G. Magnuson Institute for Biomedical Research and Health Professions Training. The law supports biomedical research into the causes, treatment and management of osteoporosis.
West Virginia	W. Va. Code § 16-5M-1 et seq. (1996) creates the Osteoporosis Prevention Education Act and requires the Bureau of Public Health to promote and maintain the program by developing strategies for educating the public and health professionals. The act also establishes the Interagency Council on Osteoporosis to coordinate the osteoporosis programs conducted by the Bureau of Public Health.
Wisconsin	Wis. Stat. Ann. § 255.06 includes osteoporosis prevention and education as part of the Well-Woman Program. The program raises public awareness concerning the causes and nature of osteoporosis, the value of early detection, and treatment options. Wis. Stat. § 534, 592 and 3482 (1997) provides funds to provide health care screening, referral, follow-up and patient education to low-income, underinsured and uninsured women. The law requires the Department of Health and Family Services to use the funding to increase women's awareness of issues that affect their health and reduce the prevalence of chronic and debilitating health conditions that affect women. The law requires the department to enhance community activities by establishing and maintaining a comprehensive women's health program that addresses all major risk factors for chronic disease for middle-aged and older women. The act also authorizes the department to support an osteoporosis prevention and education program.
Wyoming
Sources: National Conference of State Legislatures and the National Osteoporosis Foundation (www.nof.org) Note: List may not be comprehensive, but is representative of state laws that exist. NCSL appreciates additions and corrections. For more information contact: NCSL, Health Program (303) 364-7700 Resources Osteoporosis Breaks Bones and Budgets National Conference of State Legislatures, LegisBrief, April/May 2008 National Osteoporosis Foundation State Mandated Benefits: Osteoporosis Screening State Health Facts, Kaiser Family Foundation Nutrition for Everyone: Bone Health Center for Disease Control and Prevention Bone Health and Osteoporosis: A Report of the Surgeon General U.S. Department of Health and Human Services, 2004 Top of Page Women's Health Project \|\| Women's Health Resources Maternal and Child Health Project \|\| Maternal and Child Health Resources Children, Adolescent, and Women's Health Policy Topic List Health Policy Issues A to Z This site is made possible by project, MCU 1 H03 MC 00017, from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, U.S. Department of Health and Human Services.