Ask Congress to support the “Medicare Fracture Prevention and Osteoporosis Testing Act of 2009.”
As an osteoporosis patient, you know the severe impact that osteoporosis has on those living with the disease, their family and friends. Bone density tests are critical to detecting osteoporosis, improving the quality of life of osteoporosis patients and preventing debilitating and costly fractures before they occur.
Current and proposed Medicare reimbursement cuts for DXA testing can make it difficult for patients to find a DXA provider. As reimbursement continues to decline, many patients will need to travel long distances for a DXA test because fewer physicians will be able to provide bone density tests in their office.
The “Medicare Fracture Prevention and Osteoporosis Testing Act of 2009” (S. 769/H.R. 1894) would roll back Medicare reimbursement cuts for DXA testing and authorize a study of how reduced reimbursement affects patients. Please ask your Members of Congress to protect patient access to osteoporosis testing by cosponsoring this important legislation!
Visit the NOF Web site today at www.nof.org/advocacy to send your Members of Congress a message on this important issue!
Posted by Advocacy Staff at NOF
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Protect Patient Access to Osteoporosis Testing
- By Osteo_Staff_Journal
- Posted May 14, 2009 at 2:10 pm · 8 replies
- In Diagnosing osteoporosis
- Shared with the public
- Edited May 14, 2009 at 2:26 pm
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- By Eamenard
- Posted May 15, 2009 at 8:59 am
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Dear Staff:
I think that it is a great idea to stop funding of DEXA scans. They do more harm that good as DEXA does not predict fracturability and frightens people into taking unnecessary drugs.
Let's put the money into fiinding a method of helping those who need it (1 of 100) and eliminate the other 99 who don't.
- By Char42
- Posted May 15, 2009 at 11:21 am
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I agree with Eamenard, as with my other diagnostics my diagnosis is Osteopenia, latest OV my Doctor did not believe I have Osteoporosis as bad as shown in the DEXA. Other Doctors are pushing Bisphosphonates to make my life miserable. Those poisons are not necessary for my health and I have never had a fracture.
- By PikaB
- Posted May 15, 2009 at 12:17 pm
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The idea that "DEXA does not predict fracturability" is a myth perpetuated by fringe alternative therapists. A number of studies have shown the correlation between fracture risk and DEXA, for example see the top chart at
http://courses.washington.edu/bonephys/opFxRisk.html
Certainly there are other tests which could better predict fracturability. The study "Evaluation of trabecular mechanical and microstructural properties in human calcaneal bone of advanced age using mechanical testing, microCT, and DXA" indicates what some of those factors are.
http://www.ncbi.nlm.nih.gov/pubmed/17953972
complete paper at
http://bme.sunysb.edu/people/faculty/2008-JBiomech-mech-test-age.pdf
But I don't think we want to go through yearly expensive bone biopsies, or routinely get the high radiation doses emitted from CT scans. At the present time, the DEXA does give a reasonable degree of fracture predictability.
- By Stu
- Posted May 15, 2009 at 6:58 pm
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How do we measure osteoporosis (bone density) if not with a DEXA scan?
How do we let people know they have a bone problem before they find out with fracture?
Stu
- By BoneLady
- Posted May 16, 2009 at 3:23 pm
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I will ask Congress to pass the "Medicare Fracture Prevention and Osteoporosis Testing Act of 2009." I am not Medicare age yet, but I want to roll back Medicare reimbursement cuts for DXA scans for others affected by the cuts.
Bone mineral density measured by DXA scans is the usual standard for predicting the risk of fracture.
Another measure -- looking at bone turnover marker tests of blood or urine -- might be a quicker way of telling if anti-osteoporotic treatments are working to reduce fracture risk. These markers have great potential, but there's a lot of biological variability, so they are not used as much in clinical practice. I have read posts by some NOF members who get one or more of these tests performed routinely between DXA scans. I have never had one.
BoneLady
- By Eamenard
- Posted May 16, 2009 at 11:20 pm
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Dear PikaB
I respect your disagreement but your references show that there are many other significant factors that are used to predict the "probability" of fracture and DEXA is used as one of those factors. There are other parameters that are not included that people think are of significance like acidity of the your system, weight bearing excercise, serotonin of the gut, diet, calcium intake or no calcium intake, balance strength, etc, The list goes on and on but people use the DEXA as a "standard" and the only risk factor and it is totally misleading. Gillian Sampson (not sure that I spelled her name correctly) has many references in her book "The Myth of Osteoporosis" which I found very interesting that show the invalidity of DEXA.
The way in which the DEXA scan is used as if it is the gospel is the real crime. Perhaps it is a factor, but is it 20% of the story? Someone on this site quoted 80% but it is obvious to me that the data isn't there to prove that. What about all the other parameters that are not included and what is the weighting of each of those parameters? I don't know of anyone who is trying to collect this data and trying to make sense of it all.
Instead we have the DEXA which allows the drug companies to sell lots of medicines to lots of people who are really at low risk. Doctors are also benefiting as are the DEXA machine manufacturers and no one that is benefiting monetarily is going to rock the boat.
The FRAX test gathered what available data there was at hand and put it in a program but the data for the other parameters were not factored in because this data was not available. So who is going to pay to have this data collected?? The government is the only entity that I can think of to provide the money. Medicare might save some money but I am sure the drug companys wouldn't be too happy if this were done.
I have read studies that show that of 100 people taking drugs only 1 person will benefit. But 99 others are taking drugs that change the basic structure of the bone and perhaps facing an unknown future.
You have been a member of this site for some time. Look at all the ways people are running in circles because of the DEXA scan-most needlessly in my estimation. The good part is that it does get people's attention to make lifestyle changes. If we had those other parameters, then we could substantiate those lifestyle changes.
I hope you see where I am coming from. I am an engineer and my background tells me that DEXA is the worst kind of instrument. But then the body is more complex than any engineering field. So who am I to say. An engineering approach would be to "stress test" the bones and try to find an instrument that measures the quality of ones bones. But I don't think that would be too popular if you had to break the bone to find out.
But once we knew what the quality of the bone was then one would want to find ways to improve it. Then it really gets hard. So we might be forced back to the scatter gun approach. That is diet changes count for so much. Weight bearing excercises so much. Alkaline diet. Calcium so much. No smoking so much. Limiting alcohol so much. And on and on.
Who might limit their alcohol to 1 drink/day for only 1% improvement? Or walk 10 miles/day for another 1%. What about 2 miles? Hope you appreciate the humour. But it is a very complex subject. And DEXA isn't the answer by a long shot.
- By PikaB
- Posted May 17, 2009 at 8:38 am
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Eamenard:
You stated: "An engineering approach would be to 'stress test' the bones and try to find an instrument that measures the quality of ones bones. But I don't think that would be too popular if you had to break the bone to find out."
That is precisely what was done in the study I cited, at
http://www.ncbi.nlm.nih.gov/pubmed/17953972
complete paper at
http://bme.sunysb.edu/people/faculty/2008-JBiomech-mech-test-age.pdf
- By Eamenard
- Posted May 18, 2009 at 6:42 pm
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Dear PikaB:
Yeah, but the bone breaking was done to cadavers so they didn't care. The reference also states that a better test is needed as DEXA doesn't give the whole story. So lets put the money into finding that better way and motivate the industry to find that way by cutting off the money spent on DEXA tests.
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