Trends and disparities in DXA testing for osteoporosis among Medicare beneficiaries, 2005-2023

DXA utilization among Medicare beneficiaries declined 35% from 2005 to 2023. Declines were disproportionately larger among racial/ethnic minorities and socioeconomically deprived groups, while use increased among highest-acuity patients. These findings highlight widening inequities in DXA testing and underscore the need for targeted policy and public health interventions.

The objective of this study is to examine the association between demographic and socioeconomic (SES) factors and national trends in dual-energy X-ray absorptiometry (DXA) testing among Medicare beneficiaries.

This 19-year repeated cross-sectional study used 5% Medicare fee-for-service claims (2005-2023) to assess the annual utilization of DXA. Claims missing patient ZIP code, age, or race/ethnicity were excluded. Patient acuity was measured using the Neiman Imaging Comorbidity Index (NICI). Patient residence ZIP codes were used to determine urbanicity and Area Deprivation Index. Annual DXA utilization was calculated per 100,000 beneficiaries overall and stratified by SES covariates. Covariate associations with DXA utilization were assessed using logistic regression and comparisons of adjusted odds ratios (AOR) between years quantified utilization changes.

We identified 5,243,098 unique beneficiaries from 2005 to 2023 (mean 2,517,265 beneficiaries per year); 1,218,904 (23.2%) beneficiaries had at least one DXA. Annual use per 100,000 beneficiaries declined 35.4% from 7255 in 2005 to 4,690 in 2023. Hispanic beneficiaries saw the largest percentage decrease (-35.3%) in AOR of DXA utilization from 2005 (AOR, 0.93) to 2023 (AOR, 0.60), while beneficiaries with NICI ≥ 7 demonstrated the largest percentage increase (+57.7%) in AOR of DXA utilization from 2005 (AOR, 1.11) to 2023 (AOR, 1.70).

Underserved populations have seen greater declines in DXA utilization compared with the observed national decline from 2005 to 2023. Future studies should identify the underlying factors associated with these disparities to inform public health interventions that enhance equitable utilization of DXA testing across the nation.