August 6, 2026
New Study Finds DXA Osteoporosis Screening Declined 35% Among Medicare Beneficiaries
A new HPI study reveals a substantial decline in DXA testing among Medicare beneficiaries that was greatest in certain underserved groups. The findings raise concerns about missed opportunities to diagnose osteoporosis and prevent fractures and associated costs. The study, published in Osteoporosis International, analyzed nearly two decades (2005-2023) of Medicare claims data from more than 5 million beneficiaries and found that use of DXA fell by 35%, from 7,255 to 4,690 scans per 100,000 beneficiaries over the study period.
This observed decline in DXA testing was not evenly distributed. Utilization dropped most steeply among vulnerable populations, including racial and ethnic minorities and individuals living in socioeconomically disadvantaged communities. Hispanic beneficiaries experienced the largest decline in DXA use (-67%), followed by Black (-47%) and Asian (-43%) populations. Patients in resource-deprived areas (i.e., high Area Deprivation Index) also saw greater reductions in DXA testing than those with greater access to healthcare and other resources.
“This study highlights a troubling disconnect between clinical need and access to osteoporosis screening,” said Casey Pelzl, MPH, Principal Economic and Health Services Researcher and lead author. “We are seeing that use of DXA 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.”
Utilization of DXA declined 42% among those without prior osteoporosis diagnosis, while DXA testing increased 4% among patients who had a history of a preventive care visit in the prior year. In fact, having a preventive care visit was the strongest predictor of DXA testing, increasing a beneficiary’s odds of receiving a DXA nearly tenfold.
“Preventive care visits emerged as the clearest pathway to DXA testing. That suggests policy solutions should not only focus on sustainable access to DXA, 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,” said coauthor Elizabeth Rula, PhD, Executive Director of the Harvey L. Neiman Health Policy Institute.
The decline in screening observed in the study coincides with major reductions in Medicare reimbursement for office-based DXA, which dropped by more than half between 2006 and 2010. The study’s authors note that these payment changes may have reduced provider capacity and shifted services away from accessible office and clinic settings.
With regard to the broader system implications, Dania Daye, MD, PhD, Vice Chair of Practice Transformation and Director of the Center for High Value Imaging at the Department of Radiology at the University of Wisconsin-Madison and senior author said, “These findings demonstrate how policy decisions, particularly around reimbursement, can have unintended downstream effects on access and equity. Ensuring adequate support for preventive imaging services like DXA is critical if we want to reduce avoidable fractures, improve patient outcomes, and manage future healthcare costs.”
To arrange an interview with a spokesperson, contact Nichole Gonzalez at ngonzalez@neimanhpi.org.
About the Harvey L. Neiman Health Policy Institute
The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at www.neimanhpi.org and follow us on X, BlueSky or LinkedIn.