Diagnosis: Osteoporosis
Treatment: 82523 - Collagen crosslinks analysis
The health plan should not cover the proposed collagen crosslinks analysis.

This patient is a female with osteoporosis with t-score -3.4, She has been treated with Forteo and zoledronic acid. Request for collagen cross link testing is under review.

Collagen crosslinks testing is one of multiple available bone turn over markers. While the use of biochemical bone turn over markers in clinical trials has been helpful in understanding the mechanism of action of therapeutic agents, their role in the care of individual patients is not well established and are not widely used in clinical practice because of high analytical and biological variability that makes interpretation challenging. The American Association of Clinical Endocrinologists and American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis - 2016 indicates "Their use in clinical practice, however, is limited by high in vivo and assay variability (e.g., urinary resorption markers), poor predictive ability in individual patients, and lack of evidence-based thresholds for clinical decision-making." Therefore, no, the health plan should not cover the proposed treatment.

The requested health service is not more likely to be more beneficial than any standard treatment or treatments for the insured's condition.