Introduction: Fracture Prevention

Because it dramatically increases therisks for chronic disability and mortality,osteoporosis-related fractureposes a serious public health issue,especially in higher-risk populationssuch as the elderly. Even as the US populationages, commercial health planshave been largely insulated from the impactof osteoporosis-related fractures.However, the recently implemented MedicareModernization Act (MMA) maysharply reverse this trend.

The centerpiece of the MMA, a prescriptiondrug benefit plan for senior citizens whoqualify for Medicare benefits, is administeredby private insurers, either as a standaloneprogram or as a component of anexpanded Medicare Advantage Program.Formerly named Medicare + Choice, MedicareAdvantage offers financial incentives toattract managed care organizations back tothe Medicare program, and, in 2006, thisprogram will create new regional PreferredProvider Organization options that mayattract new beneficiaries, especially in ruralregions. These initiatives, together, mayspur an influx of elderly individuals into themanaged care system, elevating the importanceof osteoporosis management to anindispensable step in controlling downstreamfracture-related costs.

This supplement, based on presentationsand discussions from a roundtable, "FracturePrevention in Osteoporosis," held October 4,2005, in Nashville, Tenn, examines approachesfor identifying patients at risk forosteoporosis-related fracture, methods forassessing the level of fracture risk, and strategiesfor reducing the risk for fracture—topicsof growing interest to managed care.

In the first article, Joseph R. Tucci, MD,explores the epidemiology and pathophysiologyof, and the risk factors for, osteoporosisand osteoporosis-related fracture, as well asthe treatment options available to reduce therisk of fractures. In the second article, DianaBrixner, PhD, RPh, examines the role ofobservational studies in assessing the "realworld" cost-effectiveness of bisphosphonatesin reducing the risk of nonvertebral fracturesand in evaluating the cost associated withbisphosphonate-related side effects, a separatedriver of overall treatment costs. Thefinal article, "Managing Osteoporosis in aManaged Care Population," reflects the highlightsand conclusions from faculty discussiongroups that focused on issues such asthe challenges related to identifying andengaging patients at higher risk for osteoporosis-related fracture in the managed caresetting, who should be tested and treated forosteoporosis in commercial populations, andwhat steps can be taken by managed careorganizations to improve osteoporosis managementand, in turn, reduce the risk of costlyosteoporosis-related fractures.

For managed care professionals andphysicians, these articles provide insightsand perspectives that can contribute to anappreciation of the subpopulations at higherrisk for osteoporosis-related fractures andthe cost-effective interventions that canreduce the risk of fracture, and perhaps,may blunt the anticipated spike in costsrelated to treatment among expanding elderlymanaged care populations.

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