Language Barriers as a Driver of Health Disparity in Bone Density Screening Among the Aging Population

Osteoporosis widely affects the aging population and often leads to debilitating fragility fractures. Dual-energy X-ray absorptiometry scans are important for osteoporosis screening and treatment among aging women to prevent fragility fractures; however, disparities exist across populations. This study analyzed these disparities to help reduce screening inequalities to prevent complications of osteoporosis.

A sample was used from the 2018, 2020, and 2022 U.S. Medical Expenditure Panel Survey of women who responded about screening dual-energy X-ray absorptiometry utilization. Logistic regression modeling was used to determine the associations between social determinants of health, particularly between limited English proficiency and screening dual-energy X-ray absorptiometry utilization. Two models-social determinants of health and social determinants of health + limited English proficiency-were generated utilizing these variables modified by the addition of the variable of English proficiency.

Half of the 10,079 respondents without osteoporosis (48%, n=4,851) reported undergoing a dual-energy X-ray absorptiometry scan with a median age of 69 (50-85) years. Low income; lower education; Black, Asian, Hispanic race/ethnicity; and limited English proficiency were significantly associated with not receiving a screening dual-energy X-ray absorptiometry scan. Hispanic women had a 55% decreased likelihood of receiving a screening dual-energy X-ray absorptiometry scan (OR=0.450, 95% CI=0.365, 0.554, p<0.001) compared with non-Hispanic White women, although this lost statistical significance when accounting for limited English proficiency (OR=0.732, 95% CI=0.521, 1.029, p=0.073).

The results demonstrate significant social determinants of health disparities in dual-energy X-ray absorptiometry screening for osteoporosis. The effect is modified, specifically the association of race/ethnicity, when limited English proficiency is included as a risk factor. Awareness of these disparities is important for primary care and other providers to deliver equitable prevention and treatment opportunities for osteoporosis.