By Gabrielle Scarlett

Osteoporosis rates among women increased significantly from 2007 to 2018, according to recent data from the Centers for Disease Control and Prevention.

Among the 54 million Americans at risk for osteoporosis, 10.2 million adults have the disease and, of those with the disease, 80% are women. According to the national Osteoporosis and Hip Fracture Index, an estimated 34.4% of these cases are women between 65 to 74 and 38.5% are women over 80.

Osteoporosis weakens bone tissue, structure and strength, leading to an increased risk of fractures. The U.S. Preventive Services Task Force recommends that women 65 years and older undergo osteoporosis screening with bone measurement testing to prevent osteoporotic fractures.

A recent report commissioned by the National Osteoporosis Foundation highlights osteoporotic fractures' economic and clinical burden among Medicare beneficiaries, including the following takeaways:

• The report estimated costs of providing care for osteoporotic fractures among Medicare beneficiaries at $57 billion in 2018, including direct medical costs and indirect societal costs related to productivity losses and informal caregiving. The cost is expected to increase to over $95 billion in 2040.
• The clinical burden of osteoporosis is also significant, with osteoporotic fractures often leading to inpatient hospitalizations, subsequent fractures, pressure ulcers and death.
• Female beneficiaries had 79% higher rates of osteopathic fractures than males, after adjusting for age.
• While suffering fewer initial fractures and subsequent fractures, Black Medicare beneficiaries have higher hospitalization rates, higher death rates following fractures and lower bone mineral density screening rates. Screening rates for North American Native (6%) and Hispanic beneficiaries (7%) were also below the national average, while rates for Asian (9%) and white beneficiaries (8%) were respectively above and at the national average.

As a result, the National Osteoporosis Foundation released several recommendations around payment rates for osteoporosis screening and national education aimed at reducing fractures among older Americans. Additionally, osteoporosis-related interventions lead to fewer fractures, substantial cost savings and reduced racial disparities. Policies that bolster screening and treatment of at‐risk women could prevent 6.1 million fractures over the next 22 years while reducing payer costs by $29 billion and societal costs by $55 billion.

States with high rates of fractures have taken action to reduce this burden by providing coverage for screening and education awareness programs. For example:

• Connecticut requires health insurance policies to provide coverage for osteoporosis screening.
• Florida has a health awareness campaign for osteoporosis. The state requires group, blanket or franchise health insurance policies and health maintenance contracts to provide coverage for the medically necessary diagnosis and treatment of osteoporosis.
• Kentucky has an osteoporosis prevention and education program and requires health benefit plans to cover bone density testing for women aged 35 years and older for the purpose of early detection of osteoporosis.

Additional Resources

• National Osteoporosis Foundation, Medicare Costs of Osteoporotic Fractures: report analyzing the economic and clinical impact of osteoporotic fractures suffered by Americans insured by Medicare.
• National Osteoporosis Foundation, By the Numbers: DXA Testing: national and state breakdown of DXA bone density testing numbers.
• National Minority Quality Forum, Osteoporosis and Hip Fracture Index: searchable index on osteoporosis and hip fracture rates by state.
• American Bone Health, Fracture Risk Calculator: tool to estimate fracture risk for women and men older than age 45.

Gabrielle Scarlett is a policy analyst in NCSL's Health Program.

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