Advances favor tests to gauge osteoporosis risk.(Gynecology)

SANTA MONICA, CALIF. -- Clinicians can expect more information about their patients' bone health after referring them for dual-energy x-ray absorptiometry screening.

That's because a new ICD-9 code will soon reimburse radiologists for assessing incidental vertebral fractures along with bone mineral density.

And in another development, the International Society for Clinical Densitometry (ISCD) now advocates expanded screening for osteoporosis. In addition to traditional categories of individuals at risk, the expanded list of indications includes three new categories: men aged 70 years and older, adults with a fragility fracture, and adults with a disease or condition associated with low bone mass or bone loss.

At a symposium sponsored by the American College of Rheumatology (ACR), speakers said these advances show heightened support for early identification of patients at risk for bone loss and associated fractures.

A key development is recognition of the importance of incidental vertebral fractures, said Dr. Paul Miller of the Colorado Center for Bone Research in Lakewood. Patients with one vertebral fracture are four times more likely than others to have a subsequent vertebral fracture. But the presence of incidental fractures on dual-energy x-ray absorptiometry (DXA) scans or plain radiographs often is overlooked, he said.

Representatives of the ACR, the American College of Radiology, and the ISCD recently pressed for a new ICD-9 code providing reimbursement for incidental vertebral fracture assessment in patients with certain indications, such as loss of 4 cm or more in height after age 60.

Details about the new code, which will allow reimbursement above the amount billed for an eligible DXA scan ordered to assess bone mineral density, will be announced soon, Dr. Miller said. "This will take the field a step further because we are clearly underidentifying patients with prevalent vertebral fractures."