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Medical Criteria Needed to Qualify with Osteoporosis

In its early stages, Osteoporosis often has no signs or symptoms. However, as the disease progresses, people may experience a loss of height, a change in posture, or a new onset of back pain. The majority of individuals find out that they have osteoporosis when they unexpectedly break a bone.

In severe cases, even the slightest movement, such as a cough or a sneeze, can cause a bone fracture. Typically bone-loss alone will not qualify you for Social Security benefits. However, there is a broad range of debilitating symptoms and associated health problems that might affect your ability to work.

If you are unable to work due to osteoporosis, the Social Security Disability Insurance Program (SSDI) may be of assistance.

As approximately 10 million people in the United States have osteoporosis, not everyone will be awarded financial assistance for their disability.

Only those with the most severe cases and substantial medical evidence to back up their claims will be considered.

The Importance of the “Blue Book”

The SSA uses a medical guide, known as the Blue Book, to determine whether or not a condition such as osteoporosis is severe enough to warrant disability payments.

Osteoporosis is not listed as a disabling condition in the Blue Book. However, you might match a listing in section 1.00 of the Blue Book, which is the Musculoskeletal System.

For example, broken bones are listed in section 1.06 and 1.07.

In some instances, osteoporosis may be caused by another illness, such as an adrenal disorder. In this case, you might match the listing for that related disorder, such as in section 9.00, endocrine disorders. Sometimes those with osteoporosis suffer from kidney or autoimmune disorders as well.

So, while you might not meet a listing related to osteoporosis, it is possible that the underlying cause of your brittle bones is listed as a condition in the Blue Book.

It is of vital importance to work with your health care providers to ensure that you have completed all of the medical tests required by the SSA and that all of your medical evidence is in order.

Evidence Needed Related to Your Osteoporosis Diagnosis

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your osteoporosis. You should be able to provide the SSA with records from your physician, which should include your presenting symptoms, the progression of your bone disease, any history of bone fractures or falls, as well as the results of a full physical examination.

As osteoporosis is not specifically listed as a condition in and of itself, it is vital that your physician document the following:

  • Any inability to ambulate effectively, such as to walk reasonable distances or to use stairs
  • Any required use of assistive devices such as a cane, walker, or crutches
  • Any pain you experience related to movement
  • Any inability to perform fine and gross motor movements
  • Your ability, or lack thereof to travel without a companion to and from work
  • Any difficulties you have grocery shopping, banking, using public transportation, preparing a meal, feeding yourself, showering, etc.

Several tests will help to confirm your diagnosis, and the following should be included in your records:

  • Bone Mineral Density (BMD) test: The strength of your bones is tested using a BMD test. This is also often called a DXA scan. Results of the BMD test should include a T-score and Z-score
  • Several blood lab results might help to confirm your diagnosis, and the following labs should be included in your records:
    • Calcium levels
    • Thyroid levels, including T4, TSH, Free T3
    • Vitamin D levels
    • Alkaline Phosphatase
    • Follicle Stimulating Hormone (FSH)
    • Parathyroid (PTH)

Osteoporosis is often first identified when someone fractures a bone. If you have broken a bone, ensure that all of your imaging tests are available, including x-rays, CT scans, or MRIs. Fractured bones are also covered in section 1.06 of the Blue Book.

As a general rule, if you have fractured a bone and normal function is not expected to return for at least 12 months, you may qualify for benefits.

Records of hospitalizations should be carefully documented, including emergency room visits.

Medical Criteria Needed to Qualify with Osteoporosis

Evidence Needed Related to Your Osteoporosis Treatments

The treatment for osteoporosis depends on your quality of life and the severity of the disease. Typically speaking, osteoporosis is treated with medications and lifestyle modifications.

It is critical that your physician has documented the following:

  • Medications that you are receiving, as well as your response to those medications
  • Any surgeries or procedures that you may have had related to fractures, including operative notes or procedure notes, if applicable
  • Any related medical complications

Osteoporosis medications often have many unwanted side-effects that can affect your ability to work. From gastrointestinal disorders to irregular heartbeats, some individuals are severely impacted by osteoporosis and the medications that they are required to take for it.

Evidence Needed Related Your Quality of Life and Ability to Care for Yourself

As osteoporosis is not specifically listed in the Blue Book, it is vital that your physician document your quality of life and ability to care for yourself. The majority of people who have osteoporosis do not qualify for SSDI benefits through the Blue Book. However, you still may be too ill to work.

If this is the case, you will need to seek benefits through a medical vocational allowance.

Since osteoporosis tends to have a greater impact as we age, you might qualify for a medical vocational allowance.

Your physician should perform a residual functional capacity (RFC) assessment and speak to your specific physical limitations.

Steps You Can Take to Win Your Disability Claim

The Social Security disability claims process is cumbersome and very time consuming. However, you can expedite the process by ensuring that you have submitted all of the medical evidence related to your osteoporosis.

You will want to have a detailed discussion with your doctor and expression your intention to seek SSDI benefits.

At this meeting, you will want to review any relevant sections of the Blue Book with your physician, as meeting a listing is arguably the best way you can win an award. The Blue Book is now exclusively available online.

There are several ways that your physician can help including:

  • Ensuring that your full medical history related to your bone health is up to date
  • Listing your past treatments and responses, as well as the plan for the future
  • Documenting all of your medications and experienced side effects
  • Performing any additional blood tests or procedures that you are missing

It is very challenging to win an SSDI claim for osteoporosis, but not impossible. An experienced Social Security disability attorney or advocate can be of great assistance with your claim.

Those who seek the help of a legal expert are twice as likely to win their cases.