Medicare Coverage for Osteoporosis: Bone Density Testing and Treatment

Osteoporosis -- a condition in which bones become weak and brittle -- affects approximately 10 million Americans and causes 2 million fractures annually. Hip fractures in particular are devastating for older adults: up to 20% die within a year, and many never regain full independence. Medicare covers bone density testing and a range of treatments to prevent fractures.

Medicare covers bone density measurement (dual-energy X-ray absorptiometry, or DEXA scan) for qualifying beneficiaries:

Who qualifies:

• Women with estrogen deficiency at clinical risk for osteoporosis
• Individuals with vertebral abnormalities on X-ray suggesting osteoporosis
• Individuals receiving or planning to receive long-term glucocorticoid (steroid) therapy
• Individuals with primary hyperparathyroidism
• Individuals being monitored to assess response to osteoporosis treatment

Frequency: Once every 24 months (more frequently if medically necessary).

Cost: 20% coinsurance after the Part B deductible.

Most osteoporosis medications are covered under Part D:

Bisphosphonates (oral):

• Alendronate (Fosamax) -- generic available, low cost
• Risedronate (Actonel)
• Ibandronate (Boniva)

Bisphosphonates (IV -- Part B):

• Zoledronic acid (Reclast) -- annual IV infusion, covered under Part B as a physician-administered drug

RANK ligand inhibitors:

• Denosumab (Prolia) -- injection every 6 months, covered under Part B as a physician-administered drug

Anabolic agents (Part D):

• Teriparatide (Forteo) -- daily injection, builds new bone
• Abaloparatide (Tymlos) -- daily injection
• Romosozumab (Evenity) -- monthly injection for 12 months

SERMs:

• Raloxifene (Evista) -- reduces spine fracture risk

Physician-administered injectable osteoporosis drugs -- including Prolia (denosumab) and Reclast (zoledronic acid) -- are covered under Part B when administered in a doctor's office or infusion center.

Cost: 20% coinsurance after the Part B deductible. Medigap Plan G covers this 20%.

When osteoporosis leads to fractures, Medicare covers:

Vertebral compression fractures:

• Vertebroplasty and kyphoplasty (minimally invasive procedures to stabilize fractured vertebrae) -- covered under Part B

Hip fractures:

• Surgical repair (hip pinning, partial or total hip replacement) -- covered under Part A (inpatient) or Part B (outpatient)
• Post-surgical rehabilitation in SNF or home health

Since falls cause most osteoporosis fractures, Medicare covers fall prevention services:

• Annual Wellness Visit: Includes fall risk assessment
• Physical therapy: Balance and strength training to reduce fall risk
• Home safety assessment: Through home health services

Adequate calcium and vitamin D are essential for bone health -- but Medicare does not cover calcium or vitamin D supplements as standalone items. However, if your doctor prescribes vitamin D for a documented deficiency, it may be covered under Part D.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.