By Yoko Allen and Claire Gill

You don’t often hear about osteoporosis or weakening of the bones leading to fractures.  But this chronic disease is responsible for more hospitalizations than heart attacks, strokes, or breast cancer. An estimated 10 million Americans have osteoporosis and 44 million more have low bone density that places them at increased risk of a fracture. And a new study finds there are significant racial disparities in the care and outcomes of those who suffer osteoporotic bone fractures.

This recent study from the National Osteoporosis Foundation, finds that although Black men and women are generally less likely to suffer from osteoporosis and sustain a fragility fracture, they have higher hospitalization rates, higher death rates following fractures, and lower bone mineral density (BMD) screening rates. Black Americans suffering an osteoporotic fracture in 2016 had worse outcomes, including higher mortality, and were less likely to receive any follow-up care to address their underlying bone fragility. For those on Medicare:

– 45 percent were hospitalized within 7 days of the fracture, compared to a national average of 42 percent.

– 22 percent died within 12 months of an initial osteoporotic fracture, exceeding the national average rate of 19 percent and comparable rates for White (19 percent), Asian (16 percent), Hispanic (18 percent) and North American Native beneficiaries (18 percent).

Other studies have reported racial disparities in fracture incidence and post-fracture outcomes, particularly higher rates of mortality, debility, and destitution following a fracture among black women than among White women.

All of this comes at a high financial cost. Osteoporotic fractures suffered by those on Medicare have been estimated to cost the nation $57 billion. This is expected to grow to over $95 billion in 2040 without reforms.

The good news is that we know exactly what needs to be done to prevent these costly fractures. Medicare already pays for state-of-the-art bone density testing to identify those at risk of bone fractures, allowing for early and effective preventive steps and interventions. Medicare also pays for FDA-approved drug treatments for osteoporosis that can help reduce spine and hip fractures by up to 70 percent and cut repeat fractures by about half.  In addition, new models of coordinated, post-fracture care have proven to reduce rates of fractures. The Healthy Bones Program run by the Kaiser Permanente led to a decrease of 37.2% in hip fractures with savings of $30.8 million. 

Tragically, these effective tools are largely going unused, allowing preventable fractures to continue.  The recent study also found only 5 percent of Blacks on Medicare received bone density screening within six months of suffering an osteoporotic fracture. For the overall population it wasn’t much better – 8 percent. Other studies have shown that around 80 percent of those who have suffered a fracture have not received effective drug therapies to help prevent additional fractures. This is unacceptable.

Two simple changes could turn this around. First, Medicare payments should be updated to encourage more widespread use of model secondary fracture prevention services for beneficiaries who have suffered an osteoporosis-related fracture and are thus at risk for another fracture. Geisinger Health system in Pennsylvania has demonstrated this by raising fracture prevention treatment rates to over 70 percent among those at high risk using these model practices. Second, cuts to Medicare payment rates for osteoporosis screening which have led to an 18 percent decline in the diagnosis of older women, should be reversed either administratively or through legislation.

It’s time we paid more attention to our bone health. For too many older Black Americans, our failure to address this problem, and the health disparities associated with it, leads to broken hips, loss of independence and even death. These simple solutions will cut costs and help keep Medicare solvent. It’s time to raise our voices and call on our leaders to act.

Yoko Allen is senior program manager for the Black Women’s Health Imperative and Claire Gill is chief executive officer of the National Osteoporosis Foundation