Healthcare Policy Changes in Osteoporosis Can Improve Outcomes and Reduce Costs in the United States

Abstract

In the United States, osteoporosis affects over 10 million adults, has high societal costs ($22 billion in 2008), and is currently being underdiagnosed and undertreated. Given an aging population, this burden is expected to rise. We projected the fracture burden in US women by modeling the expected demographic shift as well as potential policy changes. With the anticipated population aging and growth, annual fractures are projected to increase from 1.9 million to 3.2 million (68%), from 2018 to 2040, with related costs rising from $57 billion to over $95 billion. Policy‐driven expansion of case finding and treatment of at‐risk women could lower this burden, preventing 6.1 million fractures over the next 22 years while reducing payer costs by $29 billion and societal costs by $55 billion. Increasing use of osteoporosis‐related interventions can reduce fractures and result in substantial cost‐savings, a rare and fortunate combination given the current landscape in healthcare policy. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Osteoporosis Epidemiology Among Adults With Cerebral Palsy: Findings From Private and Public Administrative Claims Data

“…Fracture is also a major cause of functional limitations, morbidity (eg, noncommunicable diseases), poor quality of life, and early mortality . Microsimulation forecasting models have estimated that improving osteoporosis identification by 20% among elderly women (an at‐risk population for osteoporosis) could prevent 2.6 million fractures from 2018 to 2040 (assuming adequate treatment would be applied), which could lead to reducing cumulative osteoporosis‐related costs of nearly $42 billion over the same time period . Although osteoporosis and osteoporotic fractures are more commonly studied among postmenopausal women and adults over the age of 65 years, other segments of the population are vulnerable to fracture and warrant attention .…”

“…(4,7,8) Microsimulation forecasting models have estimated that improving osteoporosis identification by 20% among elderly women (an at-risk population for osteoporosis) could prevent 2.6 million fractures from 2018 to 2040 (assuming adequate treatment would be applied), which could lead to reducing cumulative osteoporosis-related costs of nearly $42 billion over the same time period. (9) Although osteoporosis and osteoporotic fractures are more commonly studied among postmenopausal women and adults over the age of 65 years, other segments of the population are vulnerable to fracture and warrant attention. (10) For example, the risk for developing osteoporosis is higher for populations that have pediatric-onset physical disabilities, such as cerebral palsy (CP).…”

Low‐Trauma Fracture Increases 12‐Month Incidence of Cardiovascular Disease for Adults With Cerebral Palsy

“…In conjunction with the previous work highlighting skeletal fragility, our findings corroborate the need for earlier strategies post‐fracture to prevent CVD (e.g., medications, stricter treatment for CVD risk factors) among adults with CP. Previous studies in non‐CP populations provide evidence that fracture screening, better detections of skeletal fragility, and exercise, and pharmaceutical interventions have the potential to prevent fractures and reduce fracture burden by limiting the post‐fracture disease sequela. Whether preventing fracture or improving post‐fracture healthcare management would reduce CVD burden for adults with CP requires further investigation.…”

Dual Effects of Lipid Metabolism on Osteoblast Function

“…The tremendous economic impact of osteoporotic fractures (7)(8)(9) and development of comorbidities after fracture (10)(11)(12) highlight the need to understand the genetic, cellular, and endocrine mechanisms that influence bone mass. With the renewed interest in intermediary metabolism in cancer (13)(14)(15) and the recognition that bone is not merely a structural organ acting as a reserve of minerals but also an endocrine organ that can influence systemic metabolism (16)(17)(18)(19)(20)(21), research in the field of skeletal biology has coalesced over the last few years on the contributions of cellular metabolism to osteoblast function and bone formation.…”