Osteoporosis testing and treatment remain low in both Traditional Medicare and Medicare Advantage

Tej D Azad; Rachel J Wu; Kelly E Anderson; Michael Darden; Amit Jain

doi:10.1007/s00198-024-07318-8

Osteoporosis testing and treatment remain low in both Traditional Medicare and Medicare Advantage

Osteoporos Int. 2024 Nov 21. doi: 10.1007/s00198-024-07318-8. Online ahead of print.

Authors

Tej D Azad^{1

2}, Rachel J Wu^{3

4}, Kelly E Anderson^{3

5}, Michael Darden^{3

6

7}, Amit Jain^{3

8}

Affiliations

¹ Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA. [email protected].
² Hopkins Business of Health Initiative, Baltimore, MD, USA. [email protected].
³ Hopkins Business of Health Initiative, Baltimore, MD, USA.
⁴ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
⁵ Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
⁶ Carey Business School, Johns Hopkins University, Baltimore, MD, USA.
⁷ National Bureau of Economic Research, Cambridge, MA, USA.
⁸ Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.

PMID: 39570337
DOI: 10.1007/s00198-024-07318-8

Abstract

Little is known regarding osteoporosis management between Traditional Medicare (TM) and Medicare Advantage (MA). MA beneficiaries had higher rates of osteoporosis testing and higher rates of osteoporosis drug treatment initiation rates. Following an osteoporotic fragility fracture, MA beneficiaries were more likely to be prescribed osteoporosis treatment. While osteoporosis testing and treatment initiation rates are low in both TM and MA, rates tended to be higher in MA.

Purpose: Osteoporosis represents a substantial clinical challenge in the United States, particularly for older women, and requires effective care coordination. Medicare Advantage (MA) plans have financial incentives in the form of star ratings to improve osteoporosis testing and treatment. The objective of this study was to compare osteoporosis management practices between Traditional Medicare (TM) beneficiaries and MA female enrollees.

Methods: We conducted a cross-sectional study using a nationally representative 20% sample of 2017-2019 TM claims and MA encounter records. We identified 2,994,203 female TM beneficiaries and 1,924,132 MA enrollees. The exposure was enrollment in MA. The primary outcomes were the rates of guideline-recommended bone mineral density (BMD) testing and osteoporosis drug initiation following a new osteoporosis diagnosis and after a new osteoporotic fragility fracture.

Results: MA beneficiaries had higher unadjusted (22.0% vs. 19.8% in TM; P < 0.001) and adjusted rates (0.8 percentage points [p.p.] higher; P < 0.001) of BMD testing. Osteoporosis drug treatment initiation rates were higher in the MA cohort, both unadjusted (24.9% vs. 20.3% in TM; P < 0.001) and adjusted (4.0 p.p. higher; P < 0.001). Following an osteoporotic fragility fracture, MA beneficiaries were more likely to be prescribed pharmacologic treatment (28.7% vs. 21.1% in TM; P < 0.001), with an adjusted increase of 5.9 p.p (P < 0.001).

Conclusion: Overall osteoporosis testing and treatment initiation rates in both TM and MA enrollees were low, with improved rates in MA compared to TM.

Keywords: Medicare advantage; Osteoporosis; Traditional medicare; Treatment.

Grants and funding

T32 HS000029/HS/AHRQ HHS/United States