Osteoporosis care at risk in the United States.

Osteoporotic fractures are associated with significant morbidity, mortality, and healthcare expenses. The United States (US) Surgeon General has described osteoporosis as a major public health concern that is underdiagnosed and undertreated. US federal agencies have established funding for bone density testing and put methodologies in place to monitor physician performance in the care of patients with osteoporosis. The US Centers for Medicare and Medicaid Services (CMS) has established bone density testing as a key preventive medical service and encouraged patients to have this test when first enrolling in Medicare. However, recent CMS actions have reduced reimbursement for dual-energy X-ray absorptiometry (DXA) to levels that are below the cost of providing this service at many facilities. As a consequence, it is likely that the number of DXA facilities in the US will decrease, thereby limiting patient access to an important diagnostic service and resulting in fewer patients being diagnosed and treated to reduce fracture risk. Unless there is a reversal of continuing reimbursement cuts for DXA, it is projected that future fracture rates will increase; the cost to Medicare for fracture-related care will be far greater than the savings in the cost of DXA services and medications to reduce fracture risk.