Op-ed from Dean Emerita Dr. Nancy Fugate Woods

Opinion piece by Nancy Fugate Woods, the dean emerita of the UW School of Nursing, and Lynn A. Kohlmeier, an endocrinologist and osteoporosis specialist in Spokane, Washington. February 3, 2020.

Washington State Policymakers: We Need You to Address Our Bone Health Crisis

This time of year brings cold, slippery conditions – the most common season for falls that can break fragile bones. But we can do more to protect at-risk seniors. We are asking Washington state’s congressional delegation to support legislation that not only saves money, but also improves health, quality of life and independence with aging – by reducing osteoporosis-related fractures and the complications that follow.

As professionals on the frontlines of research and patient care, we know we have a bone health crisis on our hands given the increase in fractures we’re seeing – and it needs attention. Though rarely discussed, low bone density and osteoporosis affect 54 million Americans (1), often resulting in costly and deadly complications. We’ve seen firsthand countless men and women suffer the consequences of fractures or osteoporosis-related bone breaks – from pain, to loss of mobility, to institutionalization in a nursing home.

There is good news, however. With our Washington legislators’ support, Congress can pass the Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act (S.283/H.R.2693), to increase diagnostic testing and stop the increase in fractures!

Most agree that prevention is part of any solution to address rising health costs, and many conditions can be prevented or more easily managed if identified early – including osteoporosis. However, for many patients, breaking a bone is the first sign they have osteoporosis and are at high risk for future fractures. (2)

Recovery after a broken bone can come with significant complications from hospitalization, to long-term care needs, or worse. In fact, one in three adults just 50 years old and over dies within 12 months of a hip fracture, (3) and one in four ends up in a nursing home. These complications come at a staggering cost; in 2018, annual direct medical costs associated with osteoporotic fracture were estimated to be $48.8 billion and are growing. (4)

For the millions of Americans with osteoporosis, there is something we can do – an inexpensive test can help assess the risk of breaking a bone before it occurs. Using dual-energy X-ray absorptiometry (DXA), bone mineral density can be measured, and is the diagnostic testing gold standard. DXA screening is recommended for all women 65 years old or older, and those under 65 years old with risk factors, (5) as well as for men over 70 years old or at increased risk for osteoporosis. (6)

Unfortunately, DXA bone mineral density tests have declined dramatically in the United States because the Medicare reimbursement rate dropped 70 percent since 2006, making it no longer economically feasible for many providers to maintain the equipment and administer tests. In Washington state since then, the decline in reimbursement has resulted in diminished osteoporosis diagnosis and treatment, as well as increased adverse outcomes, (7) estimated at 1,822 additional hip fractures and 397 hip fracture-related deaths. (8)

A recently published study found increased DXA testing could help prevent 3.7 million fractures and reduce total direct medical costs of osteoporosis by nearly $55 billion through 2040. (9) Increasing Medicare reimbursement for DXA bone density tests would help clinicians across Washington afford to provide access to more patients, enabling earlier bone density treatment to help mitigate the personal and economic tolls of osteoporosis.

We urgently need our Washington state policymakers to sign on in support of S.283/H.R.2693. Increasing Medicare reimbursement for DXA screening is a cost-effective measure to increase access to potentially life-saving diagnostic testing. This legislation presents a critical opportunity for Congress to help millions of our citizens, and now is the time for them to act.

About the Authors
Nancy Fugate Woods, Ph.D RN, is professor and dean emerita, University of Washington School of Nursing and is Co-Chair of the Medical & Scientific Advisory Board for American Bone Health. Lynn A. Kohlmeier, MD is an endocrinologist and osteoporosis specialist in Spokane, Washington. She is a reviewer for the Journal of Clinical Densitometry, Metabolism, and Osteoporosis International, and co-founder and director of the non-profit, Strides For Strong Bones, sponsoring both community and professional events. With program director, Marla Emde, and the help of volunteers, their annual Strides For Strong Bones Race and Wunderwoman Triathlon for Osteoporosis Awareness, have provided free heel bone density screening and osteoporosis education to hundreds of men and women since 2007.


[1] NOF. Osteoporosis Fast Facts. Available at: https://cdn.nof.org/wpcontent/uploads/2015/12/Osteoporosis-Fast-Facts.pdf. Accessed October 8, 2019.

[2] Ibid.

[3] J Intern Med. 2017 Mar;281(3):300-310. doi: 10.1111/joim.12586. Epub 2017 Jan 17. https://www.ncbi.nlm.nih.gov/pubmed/28093824. Accessed October 8, 2019.

[4] Lewiecki EM, Ortendahl JD, Orgle-Vanderpuye J, Grauer A, Arellano J, et al. Healthcare Policy Changes in Osteoporosis Can Improve Outcomes and Reduce Costs. JBMR. 2019 Mar 15. Available at: https://onlinelibrary.wiley.com/doi/10.1002/jbm4.10192. Accessed October 8, 2019.

[5] U.S. Preventive Services Taskforce. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/osteoporosis-screening1. October 8, 2019.

[6] American Academy of Family Physicians. Available at: https://www.aafp.org/afp/2010/0901/p503.pdf. Accessed October 8, 2019.

[7] NOF. Osteoporosis Fast Facts. Available at: https://cdn.nof.org/wpcontent/uploads/2015/12/Osteoporosis-Fast-Facts.pdf. October 8, 2019.

[8] Braid-Forbes Health Research, LLC, Medicare Carrier 5% SAF. Cost model and projections by Peter M. Steven, PhD.

[9] Lewiecki EM, Ortendahl JD, Orgle-Vanderpuye J, Grauer A, Arellano J, et al. Healthcare Policy Changes in Osteoporosis Can Improve Outcomes and Reduce Costs. JBMR. 2019 Mar 15. Available at: https://onlinelibrary.wiley.com/doi/10.1002/jbm4.10192. Accessed October 8, 2019.