Disparities in dual x-ray absorptiometry (DEXA) scan utilization across race/ethnic groups prior to and after hip fractures

Purpose: Geriatric hip fractures are common and important sentinel events regarding bone health. While dual x-ray absorptiometry (DEXA) scans are a standard method for determining bone density, differences in use among various race/ethnic groups around the time of hip fracture may reveal disparities within the healthcare system.

Methods/Materials: The 2014 to 2016 Medicare Standard Analytic Files (SAF) PearlDiver dataset was used to identify geriatric patients sustaining hip fracture. From that cohort, those who had a DEXA scan prior or following their fracture were defined. For the defined cohorts, patient age, sex, Elixhauser Comorbidity Index (ECI), race/ethnicity, and income (based on zip code) were defined and compared with univariate and multivariate analyses.

Results: Of 58,099 hip fracture patients, only 19.8% had had a DEXA scan prior to fracture and 3.9% of the remaining group had DEXA scan following fracture. Of the hip fracture population, 91.0% identified as white and 9.0% as non-white (Native American, Black, Hispanic, Asian, or Other).

Prior to hip fracture, controlling for other variables and compared to white patients, all non-white categories were at lesser odds of having had DEXA scan. Following hip fracture, Black, Hispanic, and other patients were also at lesser odds of having DEXA scan.

Conclusions: Using a large Medicare dataset, controlling for patient age, sex, and ECI, and income marker, the current study revealed disparities in DEXA scan utilization across race/ethnic groups prior and after presenting with a hip fragility fracture. Identification of such disparities highlights the needs for improved medical access and care for this at-risk hip fracture population.