Last week, I saw a patient in my clinic who had a stress fracture. While he wasn’t in the typical age group of men who develop osteoporosis, he did have other clear risk factors that suggested that osteoporosis was certainly in play. As I discussed my concerns about the development of his condition with him, I weighed the pros and cons of ordering a bone density scan.
A bone density scan, as the name implies, is an imaging test that allows a physician to get a better understanding of the mineral density of a person’s bones. With the help of low-dose X-rays, a medical professional can assess how strong a person’s bones are to identify risk factors for different conditions, like osteoporosis.
Interestingly, during my assessment and while determining the best route forward for the patient, I considered the common reluctance insurance companies have in covering such scans in men. This reluctance is due to the “gap” in diagnostic guidelines cited in this article. If you click on that article, you’ll read that the US Preventive Services Task Force (USPSTF) released updated screening recommendations for osteoporosis. The task force reaffirmed their 2018 recommendations that all women aged 65 years or older and postmenopausal women younger than 65 years at increased risk for osteoporotic fracture should be screened. However the USPSTF specifically noted that there were no recommendations in regards to this type of screening for men. Men tend to naturally have higher bone densities for a number of different reasons, but they certainly are not immune from bone density decline.
Advocating For A Patient
Given that the patient had a fracture and other clear risk factors, if his bone density scan showed evidence of diminished bone density, he would qualify for pharmacological therapy to improve his bone mass. This treatment could help him avoid future hip and spine fractures, which can be very dangerous. I’m hoping that this very simple test that could prove an invaluable tool in preventing a very serious and very costly medical issue will be approved by his insurance company, but I’m not going to hold my breath. I anticipate needing to write a letter to appeal the insurance company’s decision in the event they deny coverage, because it’s what’s best for the patient.
Given all the individual factors at play, there’s really no health-based reason to deny coverage for the bone density scan, but because these preventative scans simply aren’t the norm in men, it’s likely that the insurance company will simply see the patient as another claim that doesn’t fit within a preconceived system.
The article talks about working to address this “gap” in osteoporosis understanding and care when comparing men and women, but the research is lacking. Much like how research on heart disease has included more men in clinical studies, our understanding of osteoporosis has been largely female-focused. Osteoporosis still affects more than two million men in the US each year, and the related complications, like falls resulting in hip or spinal fractures, are oftentimes much more severe in men than in women. That same article notes, “one analysis found that 37% of male hip fracture patients died within one year. Yet men are often forgotten in osteoporosis screening.”
Hopefully this patient gets insurance approval for his bone density scan and we as a nation can fund more research that can help us eliminate certain gender gaps in healthcare. We’d all benefit from a better understanding of how to best prevent and treat conditions that may have different onsets or risk factors based on a person’s sex.
~ Dr. Lance Silverman