Every 3 seconds an osteoporosis-related fracture occurs. Researchers estimate that nearly 10 million Americans have osteoporosis and 34 million more suffer from low bone density.
Let’s take a look at what osteoporosis is, how to treat it, and how Medicare will cover your treatment.
What is osteoporosis?
Osteoporosis is a disease that causes deterioration of bone tissue resulting in low bone mass.
A healthy bone has dense small spaces similar to a honeycomb. Osteoporosis causes these spaces to become greater – initiating the loss of density and bone strength. As the inside of the bone becomes less dense, the outside also becomes weaker.
People of any age can get osteoporosis, but it is most common in adult women.
Those who have osteoporosis are more susceptible to fractures while doing everyday activities. The disease most affects your ribs, hips, wrists, and spinal bones.
What are the symptoms of osteoporosis?
Initially, as bone loss occurs there are often no noticeable symptoms. Once bone loss is prevalent, some symptoms include:
- Back pain
- Height loss
- Poor or stooped posture
- Sudden fractures
Fractures from Osteoporosis
Unfortunately, fractures are one of the most common symptoms of osteoporosis. Fractures to the bone can occur throughout the body. Spinal and hip fractures are the most serious type of fractures that can occur. Hip fractures related to osteoporosis usually occur after a fall and often result in disability and in some cases an increased risk of death.
On the other hand, spinal fractures can occur even without a fall. Osteoporosis can cause the bones that make up your vertebrae, to weaken and sometimes collapse. A weak spine can cause back pain and even the loss of height mentioned earlier.
What causes osteoporosis?
Believe it or not, your bones are in a constant state of renewal. As you grow in your early years, your body makes new bone faster than it is getting rid of old bone. This increases your bone mass. This process is called bone remodeling. In contrast, as you age, you are losing bone mass faster than you are making it.
With that said, your risk of osteoporosis heavily depends upon how much bone mass you built up when you were younger. In a sense, you have a bank of bone mass that you built upon until you were in your 20’s and now you need that to last as long as possible.
Osteoporosis occurs when bone remodeling has an imbalance in the natural process. For those that did not acquire a high density of bone mass while they were younger, they could be more susceptible to the condition.
Additionally, the following can lead to a higher risk of osteoporosis:
- Low estrogen in women
- Low testosterone in men
- Lack of nutrients like calcium and vitamin D
- Sedentary lifestyle
- Thyroid issues
- Certain medications
It is best to talk with your doctor if you feel that you are at-risk or taking a medication that puts you at risk. Osteoporosis is all too often a silent disease, so it is best to be proactive.
Physicians primarily treat osteoporosis with the use of medication. These medications are divided into two categories: anti-resorptive and anabolic agents.
Anti-resorptive medications include a specific estrogen complex that helps to slow down bone loss while preserving bone mineral density (BMD).
Alternatively, anabolic agents are a combination of parathyroid hormones and teriparatides that will stimulate bone formation.
How effective are treatments?
The effectiveness of these treatments has many factors involved. Studies have shown that post-menopausal women with osteoporosis who went through treatment, had a reduced the risk of fracture.
With that said, there are many drugs available on the market that the effectiveness of each will differ from case-to-case – making it undoubtedly important to find a doctor that will provide you with a treatment plan that will work for you.
Is osteoporosis reversible?
In short, you cannot reverse bone loss due to osteoporosis. With that, the best goal is to work with your doctor on creating a lifestyle and medical treatment plan that will prevent further damage and fractures.
At the end of the day, taking preventative measures is the best thing you can do for your health. Experts consider osteoporosis a largely preventable disease. Here are three things you can do today to begin reducing your risk.
1. Ditch the carbonated drinks
Carbonated beverages such as soda, Champagne, and even sparkling water can deplete calcium from your bones. Harvard studied women ages 16 to 20 years old and found that half of them were already showing bone loss as a result too many carbonated drinks. Carbonated drinks have a surplus of phosphates, which also causes calcium loss. Avoid extra carbonation as much as you can.
2. Evaluate your hormone levels
It is imperative to your bone health that your estrogen, progesterone, and testosterone are at normal levels. Hormonal decline is one of the most common reasons for bone loss after menopause in women. In contrast, andropause (the male equivalent of menopause) can result in bone loss in men. It is best to regularly have your hormones checked to keep them at the appropriate levels.
3. Exercise More
Exercise tells your bones that they are needed. During exercise, your muscles will pull against your bones causing stimulation. Activities such as walking, hiking, climbing, and weightlifting can all increase bone density. Just 30 minutes of exercise a day can make a huge difference!
Does Medicare cover treatment for osteoporosis?
If you have researched Medicare, you know by now that Medicare coverage applies only to treatments that are medically necessary. Medicare has some restrictions as to what conditions must be present to cover osteoporosis treatment.
Bone Mass Measurement
A Bone Mass Measurement (BMM) is a test that examines the health of your bones. A BMM can identify osteoporosis, determine if you are at risk for fractures, and measure how your body will respond to osteoporosis treatment.
How often is it covered?
Medicare Part B covers this test once every 24 months for people who meet the criteria below. This test may be covered more often if it’s medically necessary.
All qualified beneficiaries with Medicare Part B who are at risk for osteoporosis and meet one or more of these conditions:
- A woman whose doctor determines she is both:
- Estrogen deficient
- At-risk for osteoporosis
- A person whose X-rays show possible osteoporosis, osteopenia, or vertebral fractures
- People taking prednisone or steroid-type drugs or planning to begin this treatment
- A person who has been diagnosed with primary hyperparathyroidism
- An individual who is being monitored to see if their osteoporosis drug therapy is working
Your costs in Original Medicare
Fortunately, coinsurance is waived for this screening allowing eligible beneficiaries to receive this service with no out-of-pocket cost to them. You pay nothing for this test if the doctor accepts Medicare assignment.
Osteoporosis Medications: Part A and B
Original Medicare (Part A and Part B) will pay for medications when they need to be injected (as opposed to oral medications). Medicare will also cover a home visit for a nurse to inject the drug if needed.
Who’s eligible for injectable medications?
Women who meet the following criteria:
- Have Medicare Part B
- Qualify for home health services
- Have an osteoporosis-related fracture
- Cannot give the drug to themselves, nor do they have someone who can
Your costs in Original Medicare
You pay 20% of the Medicare-approved amount for the cost of the drug, and the Part B deductible applies. You pay nothing for the home health nurse visit to inject the drug.
Osteoporosis Medications: Part D
If you have already been diagnosed,pay very close attention to your Part D or prescription drug coverage.
Finding the right Part D coverage
Each Part D drug formulary is different. Drug formularies are lists of drugs that each health insurer agrees to pay for (at least partially) for any disease or ailment. Though, the drugs available on a formulary may not be the same drug your doctor prescribes.
If you are new to Medicare and already know what drugs your doctor has prescribed you for osteoporosis, you can run a search to find the best plan for you and your osteoporosis treatment.
Alternatively, if you already have Part D and are prescribed an osteoporosis medication that is not on your formulary or is on a higher tier – you can work with your doctor to file for an exception.
Who’s eligible for Part D?
Beneficiaries that are eligible for Medicare coverage, are also eligible for the Medicare Part D. You must be enrolled in Medicare Part A and/or Part B to enroll in Part D.
What will your costs be?
The national base premium of Part D plans is $35.02. This number will vary based upon your income as well as the plan you choose to go with.
Along with your premium, you will pay copays that will be dependent upon which tier each of your drugs is listed on your formulary. These costs can add up significantly if your drugs land on higher tiers, making it more important to check the formulary prior to enrolling.