Endocrine Society calls for Medicare coverage of bone testing for testosterone-deficient men

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It is estimated that one-third of men with osteoporosis have hypogonadism. The Endocrine Society released a position statement this week calling for Medicare coverage of bone mineral density testing to be extended to men with hypogonadism in a way consistent with coverage for other beneficiaries at risk for osteoporosis.

Currently, Medicare provides coverage for DEXA scans in men only when an individual has been previously diagnosed with osteoporosis, osteopenia or has had a vertebral bone fracture. Osteoporosis continues to be an under-recognized problem in men because of limited coverage; most men found to have osteoporosis are diagnosed only after a hip or spine fracture has already occurred, according to the position statement.

“The lack of Medicare coverage for DEXA scans in men with hypogonadism results in underdiagnosis and undertreatment of osteoporosis, resulting in significant morbidity, mortality and cost to society,” Robert Vigersky, MD, president of The Endocrine Society, said in a press release.

“The benefits of extending Medicare coverage of bone density testing in hypogonadal men should be more than enough incentive to change policy,” Vigersky said. “Extended coverage can help prevent painful osteoporotic fractures and help reduce the high costs associated with those fractures.”

Studies have documented the cost-effectiveness of BMD testing in older men with no prior history of osteoporosis. In a five-year study of more than 625,000 adults aged 50 years or older who had specific risk factors for osteoporosis and fractures, researchers at Kaiser Permanente in California reported that implementation of DEXA scans, among a number of initiatives, reduced the risk for hip fracture by 37%.

In the United States, 29% of the 2 million osteoporotic fractures that occur each year are in men. In 2005, osteoporosis-related fractures in men were responsible for an estimated $4.3 billion in health care costs; by 2025, experts predict these costs will rise to $6.3 billion.
To help reduce costs, preventive bone density tests for men with low testosterone levels should be included as a national coverage requirement under Medicare Part B, according to the position statement.

“With the recent availability of a generic preparation of the bisphosphonate alendronate, coverage of BMD testing is likely cost-effective for men as young as 70, even without the presence of hypogonadism,” experts wrote in the statement. The position statement was endorsed by the National Osteoporosis Foundation.