Archives of Osteoporosis

, 8:120 | Cite as

Does insufficient access to dual-energy X-ray absorptiometry (DXA) stifle the provision of quality osteoporosis care in New Zealand?

  • Stella Milsom
  • William Leung
  • Victoria Twigden
  • Paul Mitchell
  • Mike Nowitz
  • Jillian Cornish
Original Article



Access to dual-energy X-ray absorptiometry (DXA) scanning varies significantly throughout New Zealand with the majority of scans funded privately or through the health industry. Barriers to access need to be addressed if osteoporosis guidelines are to be implemented across the country equitably, to reduce the incidence and cost of fragility fractures in New Zealand.


This study aims (1) to estimate the number of dual-energy X-ray absorptiometry scans performed in New Zealand, (2) to determine funding sources of DXA scans and (3) to determine the level of regional variation in access.


DXA scan providers in New Zealand were accessed through a nationwide database and asked to provide data on DXA scans performed in 2007. The numbers of DXA scans performed in each District Health Board (DHB) region were calculated by using a funding source and compared with DHB population estimates provided by Statistics New Zealand for 2007.


In New Zealand in 2007, 33,104 DXA scans were performed, with a population rate of 78.1 DXA scans per annum per 10,000 general population, significantly less than international guidelines. There were important regional differences in access to DXA scanning. Funding for scans was predominately by private and pharmaceutical industry funders. DHBs funded only 31 % of DXA scans during this time period.


Access to DXA scan technology varies significantly throughout New Zealand, with the majority of DXA scans funded by the private sector or health industry. Barriers to access need to be addressed if osteoporosis guidelines are to be implemented across the country in an equitable fashion and so reduce the incidence and cost of fragility fractures to New Zealand.


Bone densitometry Fragility fractures Healthcare costs 


  1. 1.
    Brown PM, O’Neill R, Leung W, Radwan E, Willingdale J (2011) Current and future economic burden of osteoporosis in New Zealand. Applied Health Economics and Health Policy 9(2):111–23PubMedCrossRefGoogle Scholar
  2. 2.
    No author (2003) Prevention and management of osteoporosis. World Health Organ Tech Rep Ser 921:1–164, back coverGoogle Scholar
  3. 3.
    Osteoporosis New Zealand. [serial on the Internet]
  4. 4.
    Statistics NZ population projections. Available at: [database on the Internet]. 2007
  5. 5.
    Mithal A, Dhingra V, Lau E (2009) The Asian Audit Epidemiology, costs and burden of osteoporosis in Asia 2009, In: International Osteoporosis Foundation.
  6. 6.
    Ewald DP, Eisman JA, Ewald BD, Winzenberg TM, Seibel MJ, Ebeling PR et al (2009) Population rates of bone densitometry use in Australia, 2001–2005, by sex and rural versus urban location. Med J Aust 190(3):126–8PubMedGoogle Scholar
  7. 7.
    Breakable bones. Osteoporosis Australia Tracking Study 50upcomau/article/2011/09/breakable-bones/ [serial on the Internet]. 2011; Available from: Scholar
  8. 8.
    Fraser WD (2004) The burden of osteoporosis and the case for disease management. Disease Manag and Health Outcomes 12(6):409–18CrossRefGoogle Scholar
  9. 9.
    Eisman J, Clapham S, Kehoe L (2004) Osteoporosis prevalence and levels of treatment in primary care: the Australian Bone Care Study. J Bone Miner Res 19(12):1969–75PubMedCrossRefGoogle Scholar
  10. 10.
    Horne G (2007) Hip fracture management in New Zealand—we need to do better. N Z Med J 120(1254):U2531PubMedGoogle Scholar
  11. 11.
    (2007) British Orthopaedic Association, British Geriatrics Society. The care of patients with fragility fractureGoogle Scholar
  12. 12.
    Marsh D, Akesson K, Beaton DE, Bogoch ER, Boonen S, Brandi ML et al (2011) Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22(7):2051–65PubMedCrossRefGoogle Scholar
  13. 13.
    Eisman JA, Bogoch ER, Dell R, Harrington JT, McKinney RE Jr, McLellan A et al (2012) Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res 27(10):2039–46PubMedCrossRefGoogle Scholar
  14. 14.
    Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2):375–82PubMedCrossRefGoogle Scholar
  15. 15.
    Port L, Center J, Britta NK, Nguyen T, Cumming R, Eisman J (2003) Osteoporotic fracture: missed opportunity for intervention. Osteoporos Int 14(9):780–4PubMedCrossRefGoogle Scholar
  16. 16.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–39PubMedCrossRefGoogle Scholar
  17. 17.
    Pharmaceutical schedule, Wellington: Pharmaceutical Management Agency (2012)Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • Stella Milsom
    • 1
    • 2
  • William Leung
    • 3
  • Victoria Twigden
    • 3
  • Paul Mitchell
    • 2
  • Mike Nowitz
    • 4
  • Jillian Cornish
    • 2
    • 3
  1. 1.Department of Obstetrics and GynaecologyUniversity of AucklandAucklandNew Zealand
  2. 2.Osteoporosis New ZealandWellingtonNew Zealand
  3. 3.Department of MedicineUniversity of AucklandAucklandNew Zealand
  4. 4.Wellington School of Medicine and Health SciencesWellingtonNew Zealand

Personalised recommendations