Many Women Are Being Over-Tested for Osteoporosis

  • Although this question was asked years ago...


    My wife had a bone density test 18 months ago and was diagnosed with severe spinal osteopenia and moderate femoral neck bone osteopenia.  Medicare only pays for the bone density test to be performed every two years.  Is it reasonable to wait another six months so insurance will cover the test.  She is not having any problems.  Is there any literature available on when you need to test a person with osteopenia?    

    Finally, yes there is some literature available about when and how often you should have your bone density checked.  For years, there has been a huge gap in the medical literature surrounding this issue about the frequency necessary for bone mass density testing. In the Journal of the American Medical Assocation (JAMA), researchers presented evidence for bone density testing be done yearly, every 5 years, or every 15 years based on the bone density T scores.

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    According to this new evidence, those who have higher risk T scores of - 2.49 to - 2.0 should get yearly tests. For those who have T scores of - 1.99 to - 1.5, bone density testing every five years is adequate. And for lower risk individuals with bone density scores of - 1.49 or higher, the bone density does not need to be tested more often than every 15 years.


    These results may have some hospitals and clinics up in arms because Medicare currently pays for bone density tests every 2 years. But if some women only need bone density tests every 15 years and if Medicare changes its reimbursement guidelines to reflect these current recommendation, then some hospitals and clinics will lose some revenues. Expect those Medicare rules to be changing because we are now discovering that many women are being over-tested for osteoporosis.


    Of course, the most important issue at hand is fracture risk assessment. People with a family history or personal history of fragile fractures might need to be tested more frequently. People who are of poor health or have poor health habits like smoking and alcohol use might need more frequent testing. The decision to test or not to test needs to be an individualized decision within some reasonable judgment.


    Why not test everyone every two years? Cost should be a limiting factor. At $250 per bone density test, that cost can add up when multiplied by millions. But even more concerning is the needless exposure to radiation that accumulates over a lifetime. Not only are women being over-tested for osteoporosis, but these same women are also being over-exposed to more radiation than absolutely necessary.


    In healthy, postmenopausal women, a repeat bone density test done 15 years after an initial test probably has very little chance of providing any new information for predicting fracture risk. Unless someone's health status and/or risk factors change, why test again at all? Maybe some women only need one initial screening test at the age of 60 and, unless anything changes, no further testing is necessary after that initial bone density screening test is done.


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    So to answer the original question about when this woman with "severe osteopenia" should be tested, based on the current medical evidence, she should be tested yearly. But wait a minute, Medicare only pays for a test every 24 months. Well, it is time for Medicare to revise their guidelines. They should allow for more frequent testing of some high risk individuals. Medicare also needs to stop paying for the unnecessary bone density tests performed on healthy, low risk individuals who are currently being over-tested.


Published On: March 14, 2012