Using CT imaging to opportunistically screen for osteoporosis could save Medicare upward of $2.5B

Using CT to opportunistically screen for osteoporosis could potentially save the Medicare program upward of $2.5 billion in a single year, according to new research published Monday. 

The bone disease impacts over 50 million older adults in the U.S., resulting in 2 million fractures annually. However, as few as 11% of eligible patients undergo recommended dual-energy X-ray absorptiometry (DEXA) screening for osteoporosis, experts write in the Journal of the American College of Radiology. 

Many patients may undergo computed tomography for other concerns, with the resulting images also useful for assessing bone health, Neiman Health Policy Institute researchers contend. They analyzed a sample of nearly 3 million Medicare beneficiaries and found that using all CT exams for this purpose could boost the osteoporosis screening rate by 113%. 

“Underutilization of DEXA results in high rates of undiagnosed osteoporosis,” study co-author Casey Pelzl, MPH, senior economics and health services analyst at the policy institute, said in a statement March 3. “Our study shows that [opportunistic use of CT] has the potential to increase osteoporosis screening rates dramatically and subsequently help patients avoid fragility fractures, as well as the astronomical medical costs sustained after treatment.”

Researchers used a 5% sample of Medicare claims spanning from 2015 to 2022 for the analysis. They pinpointed patients who underwent DEXA scans, along with those who received CT imaging of the upper lumbar spine. A total of nearly 2.9 million Medicare beneficiaries met the study criteria, of whom about 20% (or over 584,000) underwent dual-energy X-ray absorptiometry. Another nearly 23% did not receive DEXA but were subjected to CT that included the L1 vertebral body in the image. About 68% of those exams used contrast enhancement and 32% did not, the authors noted. 

Of the patients who received these computed tomography scans, nearly 1% experienced a hip fragility fracture within 1 year afterward, while 8% had a spine fracture. Experts estimated that using these noncontrast CTs opportunistically would up the osteoporosis screening rate by 76% while adding all CT exams would increase it by 113%. Opportunistic screening across all CT exams would result in upward of $100 million in cost avoidance among the study population. Previous studies have indicated that the typical treatment of a patient with osteoporosis is about $16,807. But this number can balloon to $37,543 for those who experience a spine fracture or $71,057 for a broken hip. When extrapolating their findings across the entire fee-for-service Medicare population in 2023, opportunistic CT could produce upward of $2.5 billion in savings, the authors determined. 

Experts cautioned that systems must be created to ensure osteoporosis patients see the appropriate physicians and undergo needed treatments to produce these savings. Also, further efforts are needed to utilize CT opportunistically in this fashion, they added. 

“These projections should provide more optimism to opportunistic CT advocates who see the potential for this use of diagnostic imaging,” lead author Soterios Gyftopoulos, MD, MBA, professor and vice chair of hospital operations at NYU Langone Health in New York, and colleagues wrote March 3. “That said, work still needs to be done to enable widespread availability and use of opportunistic CT in daily practice. First, there is no established method to use contrast-enhanced CT for accurate [bone density measurement]. This is an important component of the opportunities in screening and cost avoidance we have discussed. If and once contrast-enhanced CT screening techniques are validated, we will be able to more fully benefit from this type of screening, as our results suggest.”