Impact of COVID-19 Pandemic on Osteoporosis Screening Using Dual-Energy X-ray Absorptiometry

ABSTRACT

Purpose of Study Several survey studies have expressed concerns regarding a general decline in osteoporosis screening as a result of the COVID-19 pandemic. We compared our institution's experience on osteoporosis screening using dual-energy x-ray absorptiometry (DXA) before and during the COVID-19 pandemic. Methods Used Patients >=50 years who received DXA screening at our academic institution were included. Patients with DXA completed between March 1, 2018 to January 31, 2020 (pre-pandemic cohort) were compared to patients with DXA completed between March 1, 2020 to January 31, 2022 (pandemic cohort). Basic demographics including age, gender, race, and ethnicity were evaluated. DXA utilization was calculated as the number of DXA studies completed monthly. The ordering providers (primary care vs specialty care providers) and mean time from initial order to DXA completion were compared between cohorts. Chi square tests were performed for categorical data, while independent t-tests were performed for continuous data, with significance set at 0.05. Summary of Results: In total, 10,680 DXA studies were completed at our institution over the study period. From March 1, 2018 to January 31, 2020, 5,375 DXA studies were completed (pre-pandemic cohort). From March 1, 2020 to January 31, 2022, 5,305 DXA studies were completed (pandemic cohort). Mean monthly DXA utilization did not differ between cohorts (233.7+/-28.5 vs 230.7+/-59.9 studies, p=0.83). There were also no statistically significant differences when comparing total DXA procedures per quarter per year between cohorts. Patients were older in the pandemic cohort at the time of DXA completion (69.3+/-8.2 vs 68.6+/-8.3 years, p<0.001). The distributions for gender (89.6% vs 89.2% female, p=0.5), ethnicity (90.3% vs 89.3% Non-Hispanic, p=0.09), and race (74.4% vs 73.3% White, p=0.21) did not differ between cohorts. The mean time from initial order to DXA completion was shorter for the pre-pandemic cohort (79.1+/-104.4 vs 88.8+/-107.6 days, p<0.001). The ordering providers (67.2% vs 62.7% primary care providers, p<0.001) also differed. Conclusion(s) This is the first study to quantitatively compare the rates of osteoporosis screening before and during the COVID-19 pandemic. In our retrospective study, we found that DXA utilization to screen for osteoporosis was not affected by the COVID-19 pandemic. However, DXA completion was more delayed, and the ordering providers were more likely to be non-primary care providers.