DXA Screening Among U.S. Medicare Population Declines 35% Over Nearly Two Decades

A new study shows that between 2005 and 2023, the rate of dual-energy X-ray absorptiometry (DXA) examinations among U.S. Medicare beneficiaries declined significantly, by 35%. DXA is commonly used for bone density testing and osteoporosis-related screening, and the findings suggest that disparities in screening access across different populations are widening.

Researchers analyzed claims data from more than 5 million Medicare beneficiaries. The results showed that DXA utilization fell from 7,255 exams per 100,000 beneficiaries in 2005 to 4,690 per 100,000 beneficiaries in 2023. The study was published in Osteoporosis International.

The decline was not uniform across populations. Data showed that DXA utilization fell by 67% among Hispanic beneficiaries, 47% among Black beneficiaries, and 43% among Asian beneficiaries. Individuals residing in socioeconomically disadvantaged areas also experienced greater declines in testing. Among beneficiaries without a prior osteoporosis diagnosis, testing volume dropped by 42%.

The study also found a strong association between preventive care services and DXA examinations. Patients who had a preventive care visit in the past year actually saw a 4% increase in DXA utilization. Researchers noted that a preventive care visit was the strongest predictor of whether a beneficiary received a DXA exam, increasing the likelihood of testing by nearly 10-fold.

The study also analyzed Medicare payment trends. Between 2006 and 2010, reimbursement for DXA exams in office settings fell by more than half. The study authors suggest that this change may have weakened providers' capacity to perform these exams and shifted testing away from settings such as physician offices and clinics.

Researchers stated that given the importance of identifying populations at risk for osteoporosis in preventing fractures, the decline in DXA screening and its disparities across populations warrant attention. Improving access to preventive care services and maintaining the supply of DXA testing may help mitigate this trend.