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.
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