May 2026

Osteoporosis is one of the most under-recognized threats to women’s health — and one of the most preventable. During Women’s Health Month, primary care providers have a powerful opportunity to address a condition that disproportionately affects older women, drives loss of independence, and remains a persistent quality gap in Medicare and commercial populations.

Fractures should be a warning, not a missed opportunity. 

The scope of the problem. 

• One in two women over age 50 will experience an osteoporosis related fracture in her lifetime
• Osteoporosis is often invisible until the first fracture
• Hip fractures carry:
  • Increased mortality
  • High likelihood of long-term disability
  • Institutionalization risk
• Despite clear guidelines and effective treatments, too many women receive no evaluation or treatment after a fracture.

The quality measure: Osteoporosis management in women who had a fracture (OMW)

This HEDIS and Medicare Star measure evaluates the percentage of women ages 67–85 with a qualifying fracture who receive:

• A bone mineral density (DEXA) test OR
• Pharmacologic treatment for osteoporosis within 6 months of the fracture.

Fractures of the finger, toe, face, or skull are excluded.

Why it matters

• Performance remains suboptimal nationally
• Missed care = missed Star credit + patient harm 

Why Primary Care Is the Deciding Factor

While fractures may be diagnosed in emergency departments or orthopedic settings, primary care is where osteoporosis care is completed—or lost.

PCPs reconcile fracture history, order DEXA scans, initiate or continue therapy, address fall risk, and coordinate specialty referrals. If follow up doesn’t happen in primary care, the window closes.

Evidence-based Interventions that close the gap

Our Primary Engagement Team follows up with every office once a member falls into the measure and sends reminders. We aim to work together to help manage the member’s health and promote options for gap closure.

• Automatic fracture follow-up 
  • Ask every woman aged 65 years and older: "Have you had a fall or fracture since your last visit?"
  • Standing DEXA orders: particularly for women aged 67 to 85 without reent imaging - typically ordered every two years. 
• Even telehealth visits can close the gap.
  • Prompt medication initiation: the medicine needs to be filled - a prescription alone is not enough to close the measure.
    • Acceptable therapies include oral or IV bisphosphonates, Denosumab, and anabolic agents (e.g., teriparatide, romosozunab)
  • Prescribing within 180 days of fracture satisfied the measure. 

Women's health equity and access

Women with limited mobility, transportation barriers, or cognitive impairment often experience delayed or absent osteoporosis care. Primary care can mitigate this by:

• Leveraging pharmacists and care managers
• Coordinating mobile imaging
• Engaging caregivers
• In-home heel ultrasound options are available.

Heel ultrasound uses pulse‑echo ultrasound technology to measure bone density in the calcaneus (heel bone). The heel is chosen because it is prone to fracture in osteoporosis and is easy to access. A prospective study comparing heel ultrasound to dual‑energy X‑ray absorptiometry (DEXA) found: Sensitivity 53% (predicts osteoporosis), specificity 86% (predicts BMD-defined osteoporosis). This means it is good at ruling out osteoporosis but less reliable at detecting early or mild cases. It’s best as a screening tool for those who may need further testing.

Alignment With Broader Women’s Health Goals

Addressing osteoporosis ALSO supports:

• Fall prevention
• Functional independence
• Care for Older Adults (COA) measures
• Reduction in readmissions
• Healthy aging (see additional article about the role of PCPs in Healthy Aging in this edition)

It reframes women’s health beyond reproductive years—to lifelong musculoskeletal health.

A Women's Health Month call to action 

Consider asking:

• Which of my patients has fractured and never had a bone evaluation?
• How are we closing the loop after ED and hospital discharges?
• Are we using fractures as teachable moments?

The second fracture is often preventable—and primary care makes the difference.

Key Takeaway for PCPs

Osteoporosis management after fracture is not specialty care—it is primary care. And it is one of the clearest places where improving quality metrics and improving lives intersect.

Asthma is a chronic, inflammatory process of airways that can affect quality of life. Fear of asthma symptoms shouldn’t keep your patient’s from doing the things they love. With proper management, control of asthma symptoms is possible. Healthcare providers play an important role in educating their patients with asthma to keep them healthy.

What you can do to keep your patients healthy

• Determine lung function. Perform spirometry testing to find out how your patient’s lungs are working and to appropriately differentiate between Asthma and COPD. 
• Establish an Asthma Action Plan with the patient. This plan provides information and instructions on how your patients can manage their asthma, including what medications to take, how to recognize if symptoms are getting worse and what to do in an emergency. Review a minimum of every six months to determine what is working and what may need to be changed.  The American Lung Association offers a downloadable Asthma Action Plan (available in English and Spanish) you can share with your patients.
• Review medications. Make sure your patients know what medicines they are taking, and how often they should be taken, how to use them properly and what results to expect. Review Inhaler technique, to maximize their effectiveness. 
• Discuss symptoms. Talk about how often they have them and what triggers them. Make sure patient’s know the early warning signs of an Asthma attack and what to do if one occurs. 

The American Lung Association website offers key resources to inform asthma policy, provide asthma patient self-management education programs and quality improvement initiatives that are founded on evidence-based guidelines and practices. Many of these resources are downloadable and shareable. 

May marks National Older Americans Month — a timely reminder that nearly one in five U.S. adults will be over age 65 by 2030. Primary care will increasingly determine whether those added years are lived with function, independence, and purpose — or disability and harm. The 2025–2026 theme, “Flip the Script on Aging,” challenges clinicians to move beyond disease-centric care toward function focused, age-friendly medicine. 

For providers, this is now a quality, safety, and cost imperative. This review highlights breakthroughs and hot topics most relevant to primary care in older adults and provides actionable strategies that fit into routine visits.

1. From disease management to healthspan: the rise of age-friendly primary care 

The “Age-Friendly Health Systems (4Ms) Framework” has moved from theory to large scale implementation across U.S. health systems, with evidence showing reductions in hospitalizations, falls, and costs.

Why this matters in primary care:

• Preventive care for a healthy 75-year-old should not mirror preventive care for a frail 75-year-old;
• Functional status and patient goals increasingly outperform disease metrics as predictors of outcomes.

Action steps for PCPs:

• Embed one functional question per visit (e.g., falls, cognition, or fatigue);
• Document “what matters most” annually and reassess medications through that lens.

2. Polypharmacy and deprescribing are now core clinical skills

Polypharmacy remains one of the most modifiable drivers of harm in older adults, contributing to falls, cognitive decline, hospitalization, and mortality.

Major 2024–2026 reviews emphasize that deprescribing is safe and effective when done systematically in primary care—especially with pharmacist collaboration. 

Current hot topics

• The role of Medication Therapy Management (MTM) to oversee medication regimens, enhance therapeutic outcomes, and minimize side effects;
• Routine deprescribing of high-risk medications, including opioids, benzodiazepines, skeletal muscle relaxants, anticholinergics, PPIs, and dual antiplatelet therapy;
• Moving beyond Beers Criteria alone, and considering other initiatives to move toward goal concordant prescribing;
• Shared decision-making (SDM) to encourage open communication and collaboration between patients and healthcare providers, allowing informed decisions about medication use.

Action steps for PCPs: 

• Treat deprescribing as a planned intervention, not a reaction to adverse events;
• Normalize language such as: “This medication helped at one time—now let’s see if it’s still helping you.”

3. Dementia, cognition, and mental health: a spectrum, not a diagnosis

National data now estimate that up to 42% of Americans over 55 may develop dementia, with diagnoses often delayed until functional loss is substantial.

At the same time:

• Mild cognitive impairment (MCI) is increasingly recognized as modifiable;
• Anticholinergic and sedative medications remain major contributors to cognitive burden.

Breakthrough focus areas: 

• Early identification of cognitive change
• Medication induced cognitive impairment
• Integrating caregivers earlier into care planning

Action steps for PCPs:

• Recognize that mental fog and cognitive decline are NOT simply the consequences of aging. They are often adverse events of prescribed medicines;
• Review CNS active medications at least annually;
• Screen cognition when patients report “just not feeling sharp”—especially after medication changes.

4. Reframing prevention in older adults

Older Americans report growing dissatisfaction with preventive care that does not reflect how they want to live as they age.

Current geriatrics guidance emphasizes:

• Selective cancer screening;
• Functional and fall risk prevention;
• Vaccination, nutrition, and social connection;
• Avoiding over treatment that diminishes quality of life.

Action step for PCPs

• Replace “standard preventive checklists” with individualized aging plans
• Ask: “What are you hoping to be able to do two years from now?”

Why Older Americans Month Matters for Prescribers

National Older Americans Month is not symbolic—it reflects a clinical reality:

• Older adults drive the majority of prescribing complexity;
• Medication decisions increasingly determine function, independence, and dignity;
• Primary care is uniquely positioned to prevent harm before it becomes irreversible.

Flipping the script on aging means shifting from “What disease are we treating?” to “What life are we supporting?”

Closing Thought

Primary care prescribers are no longer just managing chronic disease—they are architects of aging trajectories. May’s National Older Americans Month is an opportunity to pause, reassess, and recommit to age friendly, evidence based, and person-centered care.

Effective July 1, 2026, FreeStyle Libre systems from Abbott will become the preferred brand of continuous glucose monitors (CGMs). Dexcom CGMs will no longer be covered for our Commercial and Essential Plan members as of July 1.  Medicare Advantage members will have Dexcom CGM coverage through December 31, 2026.

As health care costs continue to rise, our goal is to continue providing quality, access, and value. Moving to the FreeStyle brand of CGMs provides significant cost savings while continuing to provide appropriate, high-quality products to manage diabetes.  

If you are a provider who has patients currently using a Dexcom CGM, you may have already received a letter from us with more details, including a patient list.

The FreeStyle Libre 2 Plus and Libre 3 Plus systems are already covered, so all patients can begin switching immediately.

Members who are affected by this change have been sent a letter with instructions to call their doctor for assistance in choosing a new FreeStyle system. Patients who use insulin pumps must ensure the new CGM is compatible with their pump. (We do not anticipate many compatibility issues.)

As always, if you have any questions, please contact Provider Relations. Thank you for your continued partnership. 

Independent Health develops outreach campaigns to members in need of certain preventive services and to help make them aware of our programs and resources to help them maintain or improve their health. Here is a summary of the current outreach campaigns underway. 

Dapagliflozin, the generic version of Farxiga, is now available. We are asking providers to switch patients to the generic drug, which is covered across all lines of business. This transition can provide significant cost savings while continuing appropriate treatment.

Remember to view our up-to-date policies online.