A new study suggests that using existing CT scans to screen for osteoporosis could more than double screening rates among Medicare beneficiaries and reduce healthcare costs by up to $2.5 billion annually.

The research, published in the Journal of the American College of Radiology, was conducted by the Harvey L. Neiman Health Policy Institute, New York University Langone Health, and Massachusetts General Hospital.

The study focused on opportunistic CT (OCT), a method of assessing bone density using CT scans originally ordered for other medical reasons. By analyzing CT images that include the upper lumbar spine, researchers found that osteoporosis screening rates could increase by 113% in the Medicare fee-for-service population, without requiring additional imaging.

Currently, bone density screening is primarily conducted using dual-energy X-ray absorptiometry (DEXA), but adherence rates remain low, ranging from 11% to 18% among eligible patients. Among the 2.9 million Medicare beneficiaries included in the study, only 20.2% had undergone DEXA screening. However, a significant portion of the unscreened population had prior CT scans that could have been used to assess bone density, effectively doubling screening rates.

“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 Dr. Soterios Gyftopoulos, vice-chair of hospital operations and analytics at 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.”

Certain patient groups could see even greater benefits. According to the study, combining OCT with DEXA screening could increase osteoporosis detection rates by 715% in men and 247% in individuals aged 80 or older.

“CT has shown to be comparable to DEXA for determining bone density and fracture risk,” said Dr. Connie Chang, associate professor of radiology at Harvard Medical School. “Technology innovations in bone density measurement techniques and AI-driven algorithms have made it possible to integrate bone density screening into daily CT workflow.”

The study’s economic analysis projected that identifying osteoporosis using OCT and initiating appropriate treatment could save nearly $100 million in medical costs annually. If applied to the entire Medicare fee-for-service population, cost savings could reach $2.5 billion per year by preventing fractures and reducing associated healthcare expenses.

“Underutilization of DEXA results in high rates of undiagnosed osteoporosis,” said 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.”

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