Pre-Operative Bone Health Optimization as a Trojan Horse
Unlocking the Orthopedic Platform and Reclaiming the Patient Funnel
The musculoskeletal care ecosystem is entering a period of profound transition. Amid escalating surgical volumes, rising patient complexity, and increasing pressure to demonstrate value, orthopedic providers are searching for scalable, sustainable strategies that don’t just optimize surgical outcomes—but reimagine care delivery across the entire patient journey.
What if the key to that transformation wasn’t robotic surgery or the next implant innovation, but something far more foundational—and long overlooked?
Pre-op bone health optimization [1] is rapidly emerging as a linchpin strategy for orthopedic groups looking to evolve beyond episodic, volume-based care. What began as a quality initiative focused on fracture prevention and osteoporosis management is now beginning to resemble a Trojan Horse—an expansion of a focused clinical program that unlocks a broader transformation in orthopedic intelligence, infrastructure, and reimbursement.
This article explores why bone health optimization is the right strategic move at the right moment—and how it can serve as the launchpad for a vertically integrated, tech-enabled musculoskeletal care platform.
The true power of the Trojan Horse isn’t infrastructure. It’s infiltration—an unassuming way to smuggle in patients at scale.
Osteopenia and osteoporosis affect more than 10 million and 43 million Americans, respectively—dwarfing the Total Joint Arthroplasty (TJA) candidate pool. These patients are already walking into orthopedic clinics with pain, fractures, stiffness, or risk factors. They don’t need surgery yet—but they do need care.
The Hidden Variable in Orthopedic Outcomes
Despite decades of clinical evidence linking poor bone quality to complications such as implant loosening, periprosthetic fracture, and delayed union [2,3,4] most orthopedic care models continue to under-address skeletal fragility. The result? Avoidable re-operations, readmissions, and long-term functional deficits—all of which erode value-based performance and patient satisfaction [5,6,7].
Bone health optimization changes that calculus.
By integrating targeted diagnostics, bone-active pharmacologic interventions, and risk-based patient management into surgical workflows, practices can dramatically reduce preventable complications. Data from leading programs show decreases in periprosthetic fractures, improved implant longevity, and reduced re-intervention rates—directly translating into both better outcomes and reduced costs [8,9].
But the true value of bone health optimization goes beyond surgical success.
A Platform, Not a Program
When deployed strategically, bone health optimization creates the foundational infrastructure for a broader musculoskeletal care platform. That infrastructure includes:
Pre-operative risk stratification, incorporating imaging, lab data, and clinical risk factors
Remote Therapeutic Monitoring (RTM) workflows for ongoing patient engagement and reimbursement
AI-enhanced decision support tools to automate clinical assessments and standardize care pathways
Longitudinal data capture, including PROMs, functional assessments, and bone density trends over time
Once these capabilities are in place, orthopedic groups gain more than a fracture prevention program—they gain a scalable, interoperable digital backbone that supports longitudinal care, population health management, and alternative payment models across both surgical and nonsurgical cohorts.
This platform approach allows practices to:
Identify at-risk patients before they become high-cost cases
Manage non-operative patients with reimbursable digital tools
Automate documentation and outcome tracking with minimal workflow burden
Deliver continuous, proactive care without relying solely on in-person visits
Participate meaningfully in value-based payment arrangements and risk-sharing models
In essence, bone health optimization becomes the entry point for a population-wide digital musculoskeletal strategy.
From Episodic Care to Continuous Engagement
A major limitation of traditional orthopedic practice models is their transactional nature: a referral leads to a surgery, followed by post-op care and discharge. But increasingly, both payers and patients are demanding continuity—longitudinal care that spans prehabilitation, surgery, recovery, and long-term functional optimization.
Bone health programs, when implemented thoughtfully, break that transactional cycle.
By enrolling patients in long-term monitoring protocols, whether they undergo surgery or not, providers can shift toward a subscription-like model of care. Remote monitoring, predictive analytics, and automated outreach enable practices to stay engaged with patients across months and years—collecting real-world outcomes, supporting medication adherence, and identifying new risks early.
This continuous care model has significant financial implications. Programs can tap into Remote Therapeutic Monitoring (RTM), Chronic Care Management (CCM), and Principal Care Management (PCM) reimbursements—all of which are structured to reward ongoing engagement, not just episodic encounters.
It’s no surprise that forward-looking practices are now bundling these services into subscription-based offerings or wraparound care packages, differentiating themselves in an increasingly commoditized orthopedic landscape.
Clinical, Financial, and Operational Wins
The benefits of bone health optimization extend across every stakeholder group:
For Patients:
Reduced fracture and revision risk
Improved surgical outcomes and long-term mobility
Easier access to guided medication support and monitoring
For Providers:
Streamlined workflows for risk assessment and follow-up
Enhanced clinical decision support
Lower complication and readmission rates
Increased reimbursement through RTM and longitudinal billing codes
For Health Systems:
Decreased total cost of care in fracture-prone populations
Greater alignment with value-based purchasing contracts
Improved quality metrics, HEDIS scores, and star ratings
Actionable data for population health analytics
And importantly, the collection of PROMs and other outcomes data becomes largely automated, thanks to digital tools embedded in remote monitoring platforms. This solves a major burden for practices struggling to meet registry participation, accreditation, or payer reporting requirements.
Strategic Timing: Why Now?
Several forces are converging to make this the ideal moment for orthopedic groups to adopt bone health optimization as a strategic lever:
1. Regulatory support: RTM codes and care management reimbursements are now firmly in place and increasingly well-understood.
2. Technology readiness: Digital platforms are more interoperable, user-friendly, and customizable than ever before.
3. Market demand: Payers are prioritizing fragility fracture prevention and post-acute care optimization.
4. Demographic tailwinds: The aging population guarantees rising volumes of both elective and fragility-related orthopedic care.
In other words, the table is set. Practices that build this infrastructure now will not only improve outcomes—they’ll gain a competitive edge in delivering whole-person, continuous musculoskeletal care.
The Market Opportunity: Orthopedic-Linked Bone Health Optimization
In the U.S. alone, there are an estimated 7 million orthopedic surgeries performed annually. Clinical literature shows that approximately 30–40% of these patients have low bone mass or untreated osteoporosis—translating to ~2.5 million eligible patients per year.
By layering in:
- Bone quality diagnostics ($150–400 per patient)
- Bone-active therapy and monitoring ($500–1,200 annually)
- RTM and longitudinal care tracking ($400–600 annually)
…the total per-patient opportunity ranges from $1,200 to $1,800 per year.
Total Addressable Market (TAM):
> 2.5 million orthopedic patients × $1,200–1,800 = $3–4.5 billion annually
When expanded to include multi-year care, payer-aligned bundles, and population-based contracts, the TAM climbs toward $10–12 billion, positioning bone health optimization as a high-value wedge into the broader $80B+ musculoskeletal market.
Reclaiming the Patient Funnel: The Real Power of the Trojan Horse
Orthopedic practices have spent millions on surgical robots and glossy marketing campaigns designed to attract total joint replacement (TJR) patients. But what if the smarter move isn’t outside the walls—but already within them?
The true power of the Trojan Horse isn’t infrastructure. It’s infiltration—an unassuming way to smuggle in patients at scale.
Osteopenia and osteoporosis affect more than 10 million and 43 million Americans, respectively—dwarfing the Total Joint Arthroplasty (TJA) candidate pool. These patients are already walking into orthopedic clinics with pain, fractures, stiffness, or risk factors. They don’t need surgery yet—but they do need care.
By making bone health optimization the front door, orthopedic groups can capture these patients early, embed them in longitudinal care models, and become their trusted musculoskeletal provider long before surgery is ever needed. When the time comes for an intervention, there’s no competition—they’re already in your system.
This is how orthopedic practices reclaim the patient funnel—not through marketing flash or robot arms races, but by quietly building relationships from the inside out. It’s not about slipping past resistance. It’s about reshaping the terrain on which care is delivered
Looking Ahead: Building the Bone Health Optimization Platform (BHOF)
At the frontier of this movement is the idea of an open and integrated musculoskeletal operating system—a platform that supports imaging, planning, monitoring, and population analytics all in one ecosystem.
Pre-Operative Bone health optimization is the gateway to that future.
By starting with a clinically urgent, easily reimbursed, and broadly applicable program, practices unlock the infrastructure, workflows, and business models to expand into advanced orthopedic care.
It’s a classic Trojan Horse: unassuming at first glance, but once through the gates, capable of reshaping the entire landscape.
Conclusion: A Strategic Imperative Disguised as a Clinical Program
Bone health optimization may appear on the surface to be a narrow clinical initiative. But make no mistake—it is one of the most strategic opportunities in musculoskeletal care today. Its power lies not just in improving outcomes, but in catalyzing a shift toward continuous, intelligent, and financially sustainable care delivery.
The orthopedic practice of the future won’t be built on implants or procedures alone. It will be built on data, insight, and continuity.
And it may all start with a simple question:
Are you optimizing before you operate?
Acknowledgement: I’d like to credit Meghan Mendelson from MiCare Path for providing a significant contribution to this article.
References:
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8. Lewiecki EM, Bilezikian JP, Baim S, et al. Fracture Liaison Service Programs in the United States: Review of Published Cost-Effectiveness Analyses and Associated Outcomes. Curr Osteoporos Rep. 2020 Apr;18(2):127-137. doi: 10.1007/s11914-020-00571-z. PMID: 32112159.
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