It was interesting to review the data from Gehlbach, Fournier, and Bigelow in their article “Recognition of Osteoporosis by Primary Care Physicians.”1 The authors reviewed osteoporosis diagnosis data for a subsample of white women aged 60 years and older using National Ambulatory Medical Care Surveys from 1993 through 1997. They found that “[f]ewer than 2% of the women received diagnoses of osteoporosis or vertebral fracture, although expected prevalence is 20% to 30%.”1
Since the enactment of the Balanced Budget Act of 1997 (BBA97), Title IV, Section 4106, Medicare Part B provides for coverage of medically necessary bone mass measurements.2 Osteoporosis and vertebral fracture are 2 of the 5 covered indications for coverage. It will be interesting to review follow-up data since the 1997 survey to see if there has been an increase in primary care physicians’ utilization of bone mass measurement testing for women aged 65 years and older. The data should be favorable since implementation of BBA97.
Another interesting study would be to evaluate a subsample of men aged 65 years and older. The national BBA97 policy appears to be gender biased with respect to men. Men who have established hypogonadism are at risk for osteoporosis,3 but male hypogonadism is not a covered indication for bone mass measurement in the national Medicare policy.2 Data confirming this association could support future expansion of Medicare coverage for hypogonadism.
References
- 1.Gehlbach SH, Fournier M, Bigelow C. Recognition of osteoporosis by primary care physicians. Am J Public Health. 2002;92:271–273. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Medicare program; Medicare coverage of and payment for bone mass measurements, 63 Federal Register 34320–34328 (1998) (codified at 42 CFR §410). [PubMed]
- 3.Ross RW, Small EJ. Osteoporosis in men treated with androgen deprivation therapy for prostate cancer. J Urol. 2002;167(5):1952–1956. [PubMed] [Google Scholar]