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Bone Density and Bone Turnover Marker Monitoring After Discontinuation of Alendronate Therapy:  An Evidence-Based Decision to Do Less

Margaret L. Gourlay, MD, MPH1; Kristine E. Ensrud, MD, MPH2,3,4
[+] Author Affiliations
1Department of Family Medicine, University of North Carolina, Chapel Hill
2Department of Medicine, University of Minnesota Medical School, Minneapolis
3Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
4Department of Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
JAMA Intern Med. 2014;174(7):1134-1135. doi:10.1001/jamainternmed.2014.162.
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The clinical utility of medication monitoring has been a controversial issue in osteoporosis management. In the 19981 and 20012 coverage rules commonly called the “Bone Mass Measurement Act,” the Centers for Medicare & Medicaid Services (CMS) outlined provisions for bone mineral density (BMD) and bone turnover marker measurements for Medicare beneficiaries. The CMS covers BMD testing for 5 indications and bone turnover marker testing for 3 indications (Box), including monitoring of US Food and Drug Administration–approved osteoporosis drug therapy. The CMS authorizes BMD measurements if at least 23 months have passed since the last measurement, or more frequently “when medically necessary.”1(p34324) The CMS also summarized appropriate use of bone turnover markers, assuming documentation of medical necessity: “because of significant specimen to specimen collagen crosslink physiologic variability (15-20%), current recommendations for appropriate utilization include: one or two base-line assays from specified urine collections on separate days; followed by a repeat assay about three months after starting anti-resorptive therapy; followed by a repeat assay in 12 months after the three-month assay; and thereafter not more than annually, unless there is a change in therapy in which circumstance an additional test may be indicated three months after the initiation of new therapy.”2(p58844)

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