robert.ward@tufts.edu

The purpose was to determine the level of dual x-ray absorptiometry (DXA) utilization in three health systems and the potential impact of routine osteoporosis evaluation on CT for older women.

Electronic medical record review was performed via the mPower (Nuance) database at three independent academic medical centers in three different geographic regions of the United States by the Clinically Oriented Academic Radiology Initiative (COARDRI). Female patients, age 65 and over, who had CT studies of the chest or abdomen were identified over a three-year period (2015-2018). A sequential search then evaluated how many of these patients had also undergone a DXA scan over the same time period.

1389 of 24,803 (5.6%) of women with CT scans also had DXA scans (range: 4.4-14.1%). Specific site data was as follows: Site 1: women with CTs: 2482, women with CTs + DXA: 349 (14.1%); Site 2: women with CTs: 15429, women with CTs + DXA: 738 (4.8%); Site 3: women with CTs: 6892, women with CTs + DXA: 302 (4.4%).

Despite widely disseminated practice guidelines by the ACR, ISCD, and NOF that suggest DXA is indicated for women age 65 and older, we found DXA utilization was very low across all three health systems in older women undergoing chest and abdomen CTs. A concerted effort should be undertaken to optimize opportunistic CT assessment in order to improve detection of osteoporosis, which may be performed without any additional exam cost or radiation burden.

DXA is underutilized in older women undergoing chest and abdominal CT. Routine osteoporosis evaluation on CT represents a potential solution to improve the evaluation of patients at increased risk for osteoporosis.