March 3, 2025
Osteoporosis Screening with Opportunistic CT Could Double Screening Rates and Avoid up to 2.5 Billion in Medical Costs
A new multi-institute study demonstrates the potential prevention and economic benefits from the opportunistic use of CT (OCT), defined as screening performed using CT images that were collected for a different purpose. The study, published in the Journal of the American College of Radiology, showed that using CT imaging that includes the upper lumbar spine in its field of view to screen for osteoporosis could increase the screening rate in the Medicare fee-for-service population by 113% without requiring any additional imaging. The work was a collaboration among researchers from the Harvey L. Neiman Health Policy Institute, New York University Langone Health, and Massachusetts General Hospital.
Prior research has shown that only 11-18% of eligible patients are adherent to bone density screening, performed using dual-energy x-ray absorptiometry (DEXA). However, CT imaging that includes the upper lumbar spine, regardless of the primary indication for ordering the CT, could be used “opportunistically” for the secondary purpose of diagnosing osteoporosis, thus avoiding the costs . The new study included 2.9 million Medicare beneficiaries eligible for osteoporosis screening, of which only 20.2% had received a DEXA scan. However, among the unscreened beneficiaries, had at least one CT that could be used for osteoporosis screening to more than double the overall screening rate.
“With this study, we wanted to demonstrate the gap that OCT could potentially fill by mitigating the current poor osteoporosis screening rates in the Medicare population,” said Soterios Gyftopoulos, MD, MBA, FACR, Vice-Chair of Hospital Operations and Analytics, NYU-Brooklyn. “If we could use OCT alongside DEXA to identify more cases of osteoporosis, we could get more patients on osteoporosis treatment and help them avoid a debilitating or life-ending hip or spine fracture.”
It was also found that certain subgroups could see even greater benefit. For instance, if OCT was used alongside DEXA in male beneficiaries, they could see an increase in osteoporosis screening of 715%. Furthermore, those aged 80 or older could see a 247% increase in screening rates.
“CT has shown to be comparable to DEXA for determining bone density and fracture risk,” said Connie Chang, MD, Associate Professor of Radiology at Harvard Medical School, referencing her team’s recent work on validating the use of OCT for identifying osteoporosis patients at risk of fragility fracture. “Technology innovations in bone density measurement techniques and AI driven algorithms have made it possible to integrate bone density screening into daily CT workflow. These advancements, coupled with our new data that demonstrate the benefits of using CTs patients are already receiving to also screen for osteoporosis, may help increase buy-in on utility.”
The study’s economic analysis showed that identification of osteoporosis via OCT, followed by effective treatment of all at-risk study patients, could result in all-cause medical cost savings of almost $100 million dollars in a year. Scaling this up to the entire 2023 Medicare fee-for-service population, savings could reach nearly $2.5 billion annually.
“Underutilization of DEXA results in high rates of undiagnosed osteoporosis,” remarked Casey Pelzl, Principal Economics and Health Services Analyst at the Neiman Institute. “Our study shows that OCT has the potential to increase osteoporosis screening rates dramatically and subsequently help patients avoid fragility fractures, as well as the astronomical medical costs sustained after treatment.”
To obtain a copy of the study or to arrange an interview with a spokesperson, contact Nichole Gonzalez at ngonzalez@neimanhpi.org.
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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 Twitter, LinkedIn and Facebook.