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The biggest bang for the buck is treating the older population for which fractures are more prevalent.
Osteoporosis May be a silent disease, but its effect on people and pocketbooks is making noise. More than 1.5 million Americans experience osteoporotic fractures each year at an annual cost of nearly $14 billion to the U.S. healthcare system, according to the International Osteoporosis Foundation. It is estimated that about 40% of U.S. white women and 13% of white men aged 50 years will experience at least one clinically apparent fragility fracture in their lifetime.
The National Osteoporosis Foundation (NOF) reports that by 2010, about 12 million people over the age of 50 are expected to have osteoporosis and another 40 million to have low bone mass.
With the aging of America-baby boomers are expected to add 75 million people to the elderly population-managing osteoporosis and reducing the risk of fracture should become more of a healthcare priority. The Medicare Modernization Act and Part D are poised to place more emphasis on a condition worsening as people age.
Echoing the U.S. Preventive Services Task Force, the Surgeon General's report emphasizes the importance of bone mineral density (BMD) tests for women over age 65 years.
In addition, the report expresses concerns about existing gaps among providers and payers: physicians who suggest therapy but do not follow evidence-based guidelines, and managed care organizations who cover osteoporosis and do not see the full impact on their members, many of whom will have moved to Medicare by the time they suffer a fracture.
ADAPTING DM FOR OSTEOPOROSIS
The National Association for Quality Assurance's HEDIS standard for osteoporosis management in women who have had a fracture measures the percentage of women 67 and older who were diagnosed with a fracture and who received either a BMD test or prescription treatment for osteoporosis within six months of the date of the fracture. The measure applies only to Medicare. The results in 2003 show that much opportunity for improvement exists; only 21.2% of health plans achieved the 75th percentile, while 26.4% fell into the 90th percentile.
One effort that Touchpoint Health Plan, now owned by United HealthCare, has initiated in relationship to osteoporosis is "Everyone Teaching Compliance," a program which promotes conversation between patients and their physicians during the office visit and at the pharmacy. Printed sheets on osteoporosis, which explain the condition, what patients can do to prevent it, how much calcium is appropriate and sources of calcium, complement efforts by physicians, nurses and pharmacists to consistently educate patients about osteoporosis and calcium intake.
To approach a younger audience, pharmacists are urged to discuss calcium use with members using oral contraceptives. "The best shot at building up the skeletal structure begins in the teens," says Terry Maves, director of pharmaceutical services for Touchpoint.
Maves says, however, that the biggest bang for the buck is treating the older population for which fractures are more prevalent rather than younger women in post-menopause with less risk. "If you have limited resources, you have to decide judiciously where to use them," he says.
Robert D. Recker, MD, director, Osteoporosis Research Center, and professor of Medicine at Creighton University in Omaha, agrees with Maves that assessing risk earlier is an intelligent approach, but he is concerned that health plans will be reluctant to cover the assessment, especially if no risk factors exist. He touts the use of bone density DEXA (Dual Energy X-ray Absorptiometry) scans as the only measurement technology that provides good risk prediction data. Although he sees patients after a fracture, he prefers an earlier scan to possibly prevent the first fracture.