Diagnoses of this key clinical concern leapt 480% in 5 years, with CT a likely factor
Diagnoses of one key clinical concern have leapt 480% in just five years, with CT a likely factor. However, direct reimbursement and imaging-based screening pathways are still nonexistent, presenting potential opportunity for the specialty, experts detailed Thursday in JACR.
The condition in question is sarcopenia, characterized by the progressive loss of muscle mass and strength typically seen in older adults. Scientists first coined the term in 1989, and it earned an official disease classification code in 2016. Since then, there has been a marked uptick in diagnoses, with possible implications for radiology.
Neiman Health Policy Institute researchers recently investigated imaging’s role, examining Medicare data spanning 2017 to 2022 and representing 3 million beneficiaries. While case counts climbed substantially, the disease remained woefully underreported at 0.07% by the end of the study period. But with many individuals undergoing CT around the time of their diagnosis, researchers underlined the potential for screening programs and advancements in artificial intelligence.
“Given the underdiagnosis of sarcopenia, the increasing number of CT scans and CT scanners, and the interest in implementing AI tools … at the point of imaging care, opportunistic abdominal CT could play an important role in increasing the diagnosis of sarcopenia,” study co-author Robert Boutin, MD, a radiologist and professor with Stanford University, said in a statement April 17. “In this way, radiologists can increase their role in population health management and reduce disparities across socioeconomic groups while increasing the value to patients when abdominal CT scans are ordered.”
Experts with the Neiman Health Policy Institute—established by the American College of Radiology in 2012—used a nationally representative 5% fee-for-service Medicare sample for their study. They then extrapolated the findings across the entire federal payment program. Over a five-year period, the number of seniors with a sarcopenia diagnosis increased from about 11.7 per 100,000 beneficiaries up to 68 per 100,000. This represents a 480% increase, the authors noted, from 0.01% of beneficiaries in 2017 up to 0.07% by 2022. In comparison, the number of osteoporosis diagnoses also increased about 18% (from 7.4% up to 8.7%).
Previous studies have estimated that between 10% to 27% of the elderly have sarcopenia, with its prevalence increasing with age. Physicians typically diagnose the disease using a combo of physical performance tests and imaging such as CT or dual-energy X-ray absorptiometry. Screening for osteoporosis via DEXA is standard care, resulting in treatments that can reduce the risk of fractures.
“Contrastingly, there is no procedure code for the express purpose of screening for sarcopenia nor is imaging-based screening for sarcopenia routine or directly reimbursable,” the authors wrote.
Researchers also analyzed whether those with sarcopenia may have undergone imaging around the time of their diagnosis. They found that patients’ abdominal CT rate climbed “exponentially” starting at about 90 days before the diagnosis and peaking on that date of determination.
“These findings show a clear temporal association between abdominal CT use and a sarcopenia diagnosis, but we cannot determine from these data whether this represents intentional or opportunistic use of CT for diagnosing sarcopenia,” lead author Eric Christensen, PhD, research director of the policy institute, said in the announcement.
Boutin sees potential for the specialty to improve care for these patients, steering them toward exercise programs and nutrition support. Typical assessments for sarcopenia start with a patient questionnaire or gait speed assessment before subsequent imaging.
“Because CT is a reference standard for quantifying muscle mass, using CT scans patients are already receiving for the additional purpose of sarcopenia screening could further radiologists’ role in population health management,” he said in the announcement.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.