Does Medicare Cover Osteoporosis Screening for Both Men and Women?

Medicare Is Less Likely to Cover Osteoporosis Screening for Men

With the passage of the Affordable Care Act in 2010, Medicare expanded its coverage of preventive services. In fact, many of those services became free to beneficiaries as long as their Medicare provider accepted assignment, i.e., they agreed to the terms of Medicare's annual fee schedule. Some of these screening tests, however, are limited to people who are considered to be high risk for certain conditions. Osteoporosis is one of those conditions.

Osteoporosis and Its Complications

Osteoporosis is a medical condition characterized by architectural weakening in the bones and decreased bone mass. These changes make the bones more fragile and increase the risk of fractures, especially at the spine, hip, and wrist.

Debility from the condition can be significant due to decreased mobility, loss of independence, and chronic pain. Notably, fractures of the hip and spine are associated with an increased mortality rate as high as 20 percent  .

The International Osteoporosis Foundation estimates that someone has an osteoporotic fracture every three seconds.

Risk Factors for Osteoporosis

When you think of osteoporosis, you most likely think of women. It is true that postmenopausal women are at highest risk for the condition. Once their bodies no longer produce premenopausal levels of estrogen, the protective benefits of the hormone on their bones go away. Adult men, unless they have hypogonadism, generally have steady hormone levels (testosterone) throughout their lives.

However, decreases in the sex hormones are not the only risk factors for osteoporosis. You must also consider factors like advanced age, disorders that affect calcium metabolism (e.g., hyperparathyroidism), a family history for osteoporosis, excessive alcohol use, long-term use of certain medications (e.g., steroids), low body weight, low calcium intake, race (higher risk in white adults than in black, Hispanic, or Asian adults), a sedentary lifestyle, smoking, and vitamin D deficiency.

Qualifying for Medicare's Osteoporosis Screening

Medicare covers osteoporosis screening for people who have one or more of the following:

  • Anyone currently receiving treatment for osteoporosis
  • Estrogen deficiency or menopause
  • Predisone or steroid-type drug use
  • Primary hyperparathyroidism
  • X-rays suggestive for osteopenia or osteoporosis
  • X-ray suggestive for vertebral fracture

As you can see, screening is tailored towards women or people who already have confirmed osteoporosis or X-ray suspicion for the diagnosis. It is easy to see that many people who have modifiable risk factors are excluded.

Osteoporosis Screening for Men

Women are more likely to develop osteoporosis, but that does not mean that men do not get the condition. Over 8 million men in the United States have osteoporosis  , and they tend to have higher mortality rates than women. Unfortunately, Medicare's osteoporosis screening guidelines are not all-inclusive and men are often left out. Simply put, it is considerably harder for a man to get a bone density study or DEXA scan.

Men are less likely to be screened regardless of having known risk factors for osteoporosis. Where does that leave an elderly white man with schizophrenia who smokes? The male veteran with post-traumatic stress disorder who develops an alcohol abuse problem? The underweight senior man who cannot afford dentures and develops vitamin deficiencies because he cannot eat a regular diet? These men have verifiable medical conditions that often place them at increased risk for unfavorable lifestyle choices, choices that increase their risk for osteoporosis.

If their doctor has concerns, the test can still be ordered though it may (or may not) be covered. If Medicare agrees that the test is medically necessary, the beneficiary would pay 20 percent of the test's costs, the usual Medicare Part B coinsurance. Otherwise, the beneficiary will need to pay the full cost out of pocket.

A Word from Verywell

Medicare guidelines for osteoporosis screening are limited. A bone density scan may be pursued every 24 months for menopausal women, people with hyperparathyroidism, people on steroid medications, or people with X-ray findings that are suggestive for the condition. Men, unfortunately, will find it harder to get covered.

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Article Sources

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  1. Ioannidis G, Papaioannou A, Hopman WM, et al. Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. CMAJ. 2009 Sep 1;181(5):265-71. doi:110.1503/cmaj.081720

  2. Haentjens P, Magaziner J, Colón-Emeric CS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152(6):380. doi:10.7326/0003-4819-152-6-201003160-00008

  3. Looker AC, Frenk SM. Percentage of Adults Aged 65 and Over With Osteoporosis or Low Bone Mass at the Femur Neck or Lumbar Spine: United States, 2005–2010. National Center for Health Statistics. Published November 6, 2015.

  4. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007 Mar;22(3):465-75. doi:10.1359/jbmr.061113

Additional Reading

  • What Is Osteoporosis? International Osteoporosis Foundation. https://www.iofbonehealth.org/what-is-osteoporosis