For most of orthopedics’ history, bone quality was something to manage after surgery, if it was managed at all. That is changing fast.
Surgeons are screening for osteoporosis before elective procedures, building dedicated bone-optimization programs and, in some cases, delaying operations until a patient’s bone health improves. The shift is both clinical and financial: poor bone quality drives complications, hardware failure and revision surgery, and under Medicare’s new episode-based payment models, those downstream costs increasingly land on the hospital and the surgeon.
Seven developments showing how bone health is moving to the center of orthopedic care:
1. Surgeons are pausing operations to fix bone first: At New York City-based Hospital for Special Surgery, orthopedic shoulder surgeon Gabriella Ode, MD, now opens many surgical conversations with a single question: Has the patient had a bone-density scan? If a patient has untreated osteoporosis or has never been evaluated, she pauses surgical planning until they have seen the right specialists.
For Dr. Ode, bone quality is no longer a separate issue managed after surgery. It is part of surgical planning itself. “We, as orthopedic surgeons, understand that bone health is a critical part of how we manage these patients,” she told Becker’s.
2. Bone-optimization clinics are cutting complications: At Nashville, Tenn.-based Vanderbilt University Medical Center, spine surgeons partnered with colleagues in rheumatology and endocrinology to treat bone quality aggressively before complex deformity surgery. The results showed up in the data.
“We looked at our data and once we started the Bone Optimization Clinic, our complications significantly decreased,” said Scott Zuckerman, MD, assistant professor of neurological surgery and orthopedic surgery at Vanderbilt and co-director of the Vanderbilt Spine Outcomes Lab.
The takeaway for leaders: bone health optimization is becoming a measurable lever on surgical outcomes, not a peripheral concern.
3. Most fracture patients still fall through the cracks: The clinical case for screening is strong, but most at-risk patients are never caught. Shannon Carpenter, MD, an orthopedic surgeon and founder of The Bone Health Clinic in Lenexa, Kan., estimates that 90% of patients leave the hospital after a fragility fracture “with no diagnosis and no follow-up.”
Outside data points the same way. Research published in the Journal of Hand Surgery Global Online found that just 8% of Medicare beneficiaries who sustained an osteoporotic fracture later received a bone mineral density test.
Dr. Carpenter’s answer is a campaign called Demand the Scan, which urges women to get a baseline bone-density scan around the time of their first mammogram. The point, she said, is to move the bone-health conversation into midlife rather than waiting until something breaks.
4. Fracture prevention is becoming a hospital financial risk: Bone health used to be a quality issue. It is becoming a reimbursement issue. Under CMS’ Transforming Episode Accountability Model, mandatory for roughly 740 hospitals since Jan. 1, hospitals are accountable for the cost and quality of certain surgical episodes, including hip and femur fracture care. A new ambulatory specialty model will extend similar risk to individual spine and orthopedic surgeons beginning in 2027.
Treating fractures more efficiently is not the same as treating the disease that causes them, Dr. Carpenter argues, and addressing bone health is what would actually save Medicare money. Her warning to leaders is blunt: “Even if you’re not one of the chosen hospitals for TEAM, buckle up.”
Building the infrastructure to intervene — fracture liaison services, coordinated follow-up and bone-health clinics — takes time many systems have not yet spent.
5. An aging population is accelerating the problem: The pressure is also demographic. Americans are living longer, and women in particular now spend decades in postmenopausal life. “The average lifespan of a woman in the 1970s was 62 years old,” Dr. Carpenter said. “It’s now 82 years old.”
Osteoporosis already affects an estimated 19.6% of U.S. women and 4.4% of men age 50 and older, and prevalence among women has risen over the past decade. Dr. Carpenter compares the moment to an earlier era of cardiovascular care: clinically important and hugely expensive, but not yet met with systematic prevention. “You can replace a heart at this point,” she said. “But we can’t replace your spine.”
6. Bone quality is reshaping implants and screening tools: Device design is following the same logic. Boston orthopedic surgeon Sarav Shah, MD, was among the first in the U.S. to use a new implant built for complex shoulder fractures, the kind of fragility-driven injuries that are hardest to fix in compromised bone.
Screening is evolving too. Because dual-energy X-ray absorptiometry scanners are not always available, some spine surgeons have adopted MRI-based vertebral bone quality scoring to assess bone before surgery using imaging they already ordered.
7. Bone health is becoming a field-level priority: The topic is moving from individual practices to national policy. In June, the American Medical Association adopted a policy backing physician education on osteoporosis and broader insurance coverage for evidence-based screening and treatment, targeting a disease the group says affects an estimated 10 million Americans, with another 44 million at risk from low bone density.
It fits a broader pattern. Among the forces reshaping orthopedics heading into 2026, surgeons increasingly point to integrated, longitudinal management of musculoskeletal conditions, with bone health as one of the foundations beneath it.
For decades, orthopedic innovation focused on the operation. The next gains, a growing number of surgeons argue, will come from everything around it, including the bone beneath the implant. Or, as Dr. Carpenter put it: “We’re at our moment where it’s going to change. Because we can’t afford for it not to change.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
