Bone Health Is Where Diabetes Was in 2010 — Underdiagnosed, Undervalued, and About to Explode
Bone health doesn’t need more consensus statements or awareness months. It needs systems. It needs platforms. And above all, it needs capital.
Fifteen years ago, diabetes was the chronic disease quietly draining the U.S. healthcare system. It was highly prevalent, poorly managed, and structurally fragmented. At the time, it lacked national infrastructure, scalable care models, or serious digital innovation. But then the investment community caught on. A wave of capital followed. Platforms like Livongo, Virta, and Omada redefined the landscape—and created billions in enterprise value in the process.
Today, bone health is at that same inflection point, but with even more urgency and far less capital.
The Chronic Disease No One Talks About
Osteoporosis affects more than 54 million Americans, yet it remains the least systematized chronic condition in our healthcare infrastructure. While diabetes gets routine HbA1c monitoring, cancer gets multidisciplinary care teams, and CVD gets aggressive prevention models, osteoporosis is still treated like a specialty side issue—often overlooked until a catastrophic fracture occurs.
And fractures are catastrophic.
More than two million fragility fractures occur in the U.S. each year. Hip fractures, in particular, are often life-changing. Roughly 20% of patients die within a year of a hip fracture. The majority never regain their prior level of mobility or independence. The downstream costs—hospitalizations, nursing homes, rehospitalizations, home care—are immense.
Yet, incredibly, less than 20% of fracture patients are ever evaluated or treated for osteoporosis after their event. No diagnosis. No treatment. No follow-up. Compare that to a heart attack or stroke—where patients are automatically entered into tightly managed secondary prevention programs—and the disparity becomes shocking.
A Cost Crisis Hiding in Plain Sight
The U.S. spends over $400 billion annually on diabetes, and more than $400 billion on cardiovascular disease. These conditions receive top-tier research funding, dedicated quality measures, and robust payer incentives. Osteoporotic fractures—despite costing over $57 billion annually today and forecasted to surpass $95 billion by 2040—remain largely ignored.
This isn’t because the science is unclear. Osteoporosis is highly diagnosable, highly treatable, and highly preventable. DXA scans provide clear risk stratification. Injectable medications like denosumab and romosozumab reduce fracture risk by 50% or more. AI can now identify vertebral fractures from routine imaging. And digital tools exist to monitor patients remotely.
What’s missing is not the clinical pathway. What’s missing is the investment to connect, scale, and sustain it.
Why Bone Health Has Been Left Behind
Unlike diabetes or cancer, no single specialty "owns" osteoporosis. Primary care physicians are often too overloaded. Endocrinologists are too few. Orthopedic surgeons see the consequence—a fracture—but often lack the tools or mandate to manage the disease behind it.
This fragmentation has stalled both innovation and investment. While MSK rehab has attracted billions through platforms like Hinge Health, and telehealth companies have scaled behavioral care, bone health remains on the outside—a clinical orphan in a world of chronic care empires.
Even pharmaceutical success hasn't translated into care delivery infrastructure. Amgen’s Prolia alone generated $4.6 billion in revenue in 2024, yet the ecosystem around it—patient access, injection support, adherence monitoring—remains archaic.
Osteoporosis care, in many places, still depends on fax machines and referrals to nowhere.
The Market Is Ready. The Infrastructure Isn’t.
Here’s the paradox: the market fundamentals for bone health are stronger than ever.
The population is aging rapidly. By 2030, over 70 million Americans will be over age 65. A full half will have low bone mass or osteoporosis. Fractures are increasing in both incidence and severity. And we now have biosimilars entering the market, which will dramatically reduce cost barriers to treatment.
Meanwhile, CMS and commercial payers are opening new reimbursement pathways for chronic condition management—remote therapeutic monitoring (RTM), chronic care management (CCM), and remote physiologic monitoring (RPM)—all of which map perfectly onto osteoporosis management.
What we’re lacking is the connective tissue: a scalable platform that can link diagnostics, treatment, digital monitoring, and provider enablement into a cohesive system.
Source: digitalbonehealth.org
The Opportunity Is the Platform
That’s what diabetes didn’t have in 2010—and why companies like Livongo and Virta succeeded. They didn’t invent new medications or diagnostics. They created a system that made chronic care scalable, measurable, and fundable.
That is exactly what bone health needs now.
Platforms like the Bone Health Optimization Platform (BHOP), supported by the American Society of Osteoporosis Providers (ASOP), are beginning to build that system—embedding screening into orthopedic clinics, enabling point-of-care treatment with biosimilars, and leveraging RTM to sustain digital monitoring. They are training ASOP-certified providers, creating closed-loop care pathways, and enabling value-based contracts built on fracture prevention.
But they cannot do it without capital.
The Investment Case: Not Niche, Platform-Scale
This is not a small market. Bone health touches over 30 million high-risk adults in the U.S. alone. Capturing just 10% of that market—3 million patients—translates into billions in potential value across drug delivery, digital care, imaging, care navigation, and certification.
This is a space with:
High-acuity, high-cost outcomes (fractures)
Clear, binary events (did a fracture happen again or not?)
Evidence-based treatment pathways
Strong payer interest in prevention and cost avoidance
From an investor’s perspective, this is the ideal mix: a large unmet need, a rising cost curve, proven interventions, and a platform model waiting to be built.
It’s not a question of “if” this market will grow—it’s a question of who will build the infrastructure to lead it?
Conclusion: Capital Is the Catalyst
Bone health doesn’t need more consensus statements or awareness months. It needs systems. It needs platforms. And above all, it needs capital.
If diabetes was the chronic disease that defined the last decade of digital health investment, osteoporosis is the one that will define the next.
The clinical need is massive. The tools are here. The moment is now.
All that’s missing is the belief—and the capital—to build what comes next.
Peter T. Bianco, MBA
peter.bianco@theASOP.org
