1758 – Expansion of MBS item numbers 12320 & 12322 for bone mineral density testing to include patients aged 60-69 years

The application will assess the cost-effectiveness and total cost of amending the current age restriction for MBS items 12320 and 12322 to include patients aged 60 to 69 years to align with proposals to amend the age restriction for PBS listed osteoporosis medicines for primary prevention of fracture.

Medicare Benefits Schedule (MBS) items 12320 and 12322 currently provide for bone densitometry, using dual energy X‑ray absorptiometry or quantitative computed tomography, in patients aged 70 years of age and over. Bone densitometry measures a patient’s bone mineral density (BMD) and compares the patient’s BMD with the average BMD of young healthy adults (called a T-score).

Type: Investigative, codependent technology

Osteoporosis is a condition in which the bones become fragile and brittle, leading to a higher risk of fractures (breaks or cracks) than in normal bone. Diagnosis of osteoporosis requires an assessment of BMD. Patients with osteoporosis are defined as those with a T-score of -2.5 or lower.

Fractures due to osteoporosis (osteoporotic fractures) can lead to changes in posture, muscle weakness, loss of height and bone deformity of the spine. Fractures can lead to chronic pain, disability, loss of independence and even premature death.

Patients aged 70 years or older with osteoporosis (defined as those with a BMD T-score of -2.5 or less) and without a history of minimal trauma fracture, can access osteoporosis medications listed on the Pharmaceutical Benefits Scheme (PBS) for primary prevention of fractures.

The Pharmaceutical Benefits Advisory Committee (PBAC) has considered proposals to expand the current age restriction for PBS listed osteoporosis medicines for primary prevention of fractures to include patients aged 60 to 69 years. However, the PBAC deferred making a recommendation to amend the current age restriction for PBS listed osteoporosis medicines for primary prevention of fracture to include patients aged 60 to 69 years, pending a review of the MBS implications, to ensure that the bone densitometry MBS items could be aligned with the PBAC recommendations.

See the:

• PBAC outcome for the Osteoporosis Therapy Restrictions Review (PDF)
• public summary document for risedronic acid (November 2022).

• PASC consultation: Expedited – bypassing PASC
• MSAC consultation: Closed Friday 14 June 2024

• PASC meeting: Expedited – bypassing PASC
• ESC meeting: 13 June 2024
• MSAC meeting: 1–2 August 2024