A new study by researchers at NYU Langone Health, Massachusetts General Hospital, and the Harvey L. Neiman Health Policy Institute found lower rates of osteoporosis screening among Asian American (15%) and other non-white Medicare beneficiaries (11-15%) in the U.S. when compared with the screening rate among white beneficiaries (18%). This study, funded in part by RSNA’s “Emerging Issues” grant and published in March by Skeletal Radiology, was based on more than 3 million Medicare beneficiaries fee-for-service claims (2015-2020). 

Most published literature on osteoporosis and dual-energy X-ray absorptiometry (DXA) preventive screening has placed focus on osteoporosis as a disease primarily affecting non-Hispanic white women. “Osteoporosis and DXA research in Asian Americans is limited and oftentimes conflicting, even though the National Health and Nutrition Examination Survey (NHANES) showed that Asian American populations – both men and women – have the highest age-adjusted prevalence of osteoporosis”, said Connie Chang, MD, radiologist at Massachusetts General Hospital and associate professor at Harvard Medical School. “This group should really be scanned much more frequently in order to avoid osteoporosis-related fractures.”

The study showed that odds of getting a DXA scan were higher among those who were white, younger (age < 80), those living in a micropolitan area, and those with higher community income. In the 10 states with the highest proportions of Asian American inhabitants, Asian American beneficiaries consistently had lower DXA rates than white residents in each of those states, except in California. These differences were most notable in Hawaii, Massachusetts, New Jersey, New York, and Virginia.

“Osteoporosis screening rates tend to be lower in non-white populations, and we found that DXA screening rates among Asian Americans were even lower than we expected. These low rates were also seen in other non-white Medicare beneficiaries,” said Casey Pelzl, MPH, Senior Economics and Health Services Analyst at the Neiman Health Policy Institute. “After adjusting for patient factors such age and sex, we identified significant deficiency in Asian American beneficiaries screening rates when compared to beneficiaries of other races and ethnicities.” 

“It is difficult to pinpoint the reasons behind these lower DXA screening rates among Asian American beneficiaries,” said Dr. Soterios Gyftopoulos, Chief of Radiology at NYU Langone-Brooklyn. “However, we do know there are some hurdles to preventive health screenings for non-white beneficiaries. These include lower perceived risk of adverse health events, decreased awareness of screening guidelines, and various cultural factors. These challenges must be considered when designing programs to improve screening rates and reduce the observed disparities.” 

(Newswise/RMP)