This 19-year repeated cross-sectional study used 5% Medicare fee-for-service claims (2005–2023) to examine trends in DXA utilization among 5,243,098 unique beneficiaries, stratified by race/ethnicity, socioeconomic status (Area Deprivation Index), urbanicity, and patient acuity (Neiman Imaging Comorbidity Index).
Annual DXA use fell 35.4% overall (7,255 to 4,690 per 100,000 beneficiaries). Hispanic beneficiaries had the steepest drop in adjusted odds of DXA use (AOR 0.93 → 0.60; −35.3%), while the highest-acuity patients (NICI ≥ 7) saw the largest increase (AOR 1.11 → 1.70; +57.7%). Socioeconomically deprived and rural groups also showed disproportionately larger declines.
- Study is limited to fee-for-service Medicare; findings may not generalize to Medicare Advantage or younger populations. - Claims data cannot capture patient-level reasons for not receiving DXA (e.g., patient refusal, guideline changes, provider bias). - Race/ethnicity coding in claims data may misclassify some individuals.
Overall DXA use has fallen sharply since 2005, but the burden falls hardest on Hispanic patients and those in socioeconomically deprived areas—groups already at risk for undetected osteoporosis. Clinicians should proactively identify and screen these patients, and health systems should audit DXA referral patterns for equity gaps.
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