Osteoporosis DXA scans have declined by more than 35%
Dual-energy X-ray absorptiometry (DXA) scan utilization has declined significantly over the last couple of decades among Medicare beneficiaries, with minority groups being most adversely affected.
DXA scans are considered the gold standard method to screen for osteoporosis but have been historically underutilized. And improvements in access to the exams over the years do not appear to have increased adherence to screening recommendations for osteoporosis; in fact, DXA screening rates declined by around 35% between 2005 and 2023, with the steepest decreases occurring among racial, ethnic and socioeconomically disadvantaged populations, according to a new national study.
“Declines were disproportionately larger among racial/ethnic minorities and socioeconomically deprived groups, while use increased among highest-acuity patients,” Casey E. Pelzl, with the Harvey L. Neiman Health Policy Institute, and colleagues noted in Osteoporosis International. “These findings highlight widening inequities in DXA testing and underscore the need for targeted policy and public health interventions.”
For their work, researchers analyzed 5% Medicare fee-for-service claims spanning 19 years, representing more than 5.2 million unique beneficiaries. The annual utilization of DXA imaging was stratified based on a number of patient-specific factors to determine how use of the exam might vary between differing demographics.
Overall, the team determined, DXA utilization fell by 35.4%, dropping from 7,255 scans per 100,000 beneficiaries in 2005 to 4,690 per 100,000 in 2023.
However, this decline was not evenly distributed across patient populations. Hispanic patients experienced the largest decrease in DXA use, while patients living in more socioeconomically deprived areas also saw disproportionately larger declines.
In contrast, utilization increased among patients with the highest medical complexity as measured by the Neiman Imaging Comorbidity Index. Beneficiaries with the greatest comorbidity burden showed a nearly 58% increase in the odds of receiving a DXA scan during the study period.
The findings indicate that, although DXA use has declined nationally, underserved populations have experienced the greatest reductions in access to bone density testing. Pelzl and colleagues call for additional research exploring what factors might be driving these disparities, the objective being to help inform policies aimed at improving equitable access to osteoporosis screening.
Read more here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.