Demographic and clinical differences between individuals with and without DXA scans in Denmark.

UNLABELLED: This study utilized two Danish registry-based cohorts to compare characteristics of DXA scanned individuals with not DXA scanned individuals. DXA scanned individuals had more comorbidities and used more medications, but there were signs of insufficient DXA scanning, particularly regarding prior major fractures and systemic glucocorticoid use. BACKGROUND: Osteoporosis is increasingly prevalent, yet many high-risk individuals remain undiagnosed and unscanned with dual-energy X-ray absorptiometry (DXA). We aimed to describe DXA use in Denmark, focusing on characteristics, comorbidities, and medication use among scanned versus non-scanned individuals, and to assess changes over time by comparing 2000-2010 with 2011-2021. METHODS: We conducted a nationwide cross-sectional study using two Danish registry-based cohorts: individuals with fractures and individuals with diabetes, each matched to controls without these conditions. Individuals aged ≥50 years with a first DXA scan between 2000 and 2021 were identified and compared with sex- and birth year-matched individuals without a recorded DXA scan regarding comorbidities, prior fractures, lifestyle-related risk proxies, and medication use. Descriptive statistics and standardized mean differences were used overall and across time periods. RESULTS: We included 379,686 and 348,980 individuals with a recorded DXA and 1,571,452 and 1,736,828 individuals without a DXA from the two databases. DXA recipients were older, more often female, and had a greater burden of comorbidities, prior fractures, and use of centrally acting, cardiovascular, and anti-osteoporotic medications. These differences were more pronounced in 2011-2021. Nevertheless, a substantial proportion of individuals with major fractures or users of systemic glucocorticoids had never undergone DXA. CONCLUSION: DXA utilization in Denmark increasingly targets individuals at high fracture risk, yet significant gaps persist in secondary fracture prevention. Improved identification and assessment of high-risk patients - particularly those with major fractures - remain essential.