Bone scan testing for osteoporosis screening has declined by 35% among Medicare beneficiaries over nearly two decades, according to a study published August 6 in Osteoporosis International.
A team led by Casey Pelzl, of the Harvey L. Neiman Health Policy Institute (HPI) in Reston, VA, analyzed Medicare claims data for dual-energy x-ray absorptiometry [DEXA] testing between 2005 and 2023 from more than 5 million beneficiaries, with findings further raising concerns that declines in testing were greatest among certain underserved groups.
“This study highlights a troubling disconnect between clinical need and access to osteoporosis screening,” Pelzl said, in a HPI news release. “We are seeing that use of DEXA testing declined most sharply in populations that already face higher barriers in accessing care. That has real consequences for fracture prevention, health equity, and long-term Medicare spending.”
Over 50 million Americans aged 50 and older live with osteoporosis or osteopenia, yet nearly 70% of osteoporosis cases go undiagnosed until a fragility fracture occurs, the authors wrote. Medicare covers DEXA scans every two years for eligible women aged 65 and older, with early diagnosis associated with effective treatment and downstream fracture prevention, they added.
While prior research has noted declining DEXA use, little evidence is available on how race, ethnicity, community income, and area-level deprivation relate to the long-term national decline, the researchers added. To fill the gap, the group analyzed Medicare fee-for-service claims from 2005 to 2023 encompassing 5,243,098 unique beneficiaries aged 65 and older.
According to the results, DEXA use fell 35.4% from 7,255 scans per 100,000 beneficiaries in 2005 to 4,690 in 2023, with declines disproportionately greater among racial and ethnic minorities and socioeconomically deprived groups. Hispanic beneficiaries experienced the largest decline in DEXA use (-67%), followed by Black (-47%) and Asian (-43%) populations. Patients in resource-deprived areas also saw greater reductions in DEXA testing than those with greater access to healthcare and other resources, the researchers noted.
“Preventive care visits emerged as the clearest pathway to DEXA testing. That suggests policy solutions should not only focus on sustainable access to DEXA, such as ensuring adequate reimbursement for the scan, but also on improving access to primary and preventive care, especially in underserved and under-resourced communities,” added HPI Executive Director and coauthor Elizabeth Rula, PhD.
Ultimately, the decline coincides with major cuts to Medicare reimbursement for office-based DEXA, which dropped from $139 in 2006 to $56 by 2010, the authors noted. They suggested that this may have reduced provider capacity and moved services away from accessible clinic settings.
Future research should identify the specific factors driving disparate DEXA use to inform targeted public health interventions, they added, and examine whether opportunistic CT scans for osteoporosis identification can serve as a complementary screening pathway, the researchers concluded
Read the full study here.