Sarcopenia Diagnosis Trends and Opportunistic Use of Abdominal CT Among Medicare Beneficiaries.

Abstract

Objective: To estimate the share of the Medicare fee-for-service population with sarcopenia compared with osteoporosis, an associated age-related disease, using claims data and to assess abdominal CT use in the diagnosis of sarcopenia compared with dual-energy x-ray absorptiometry for the diagnosis of osteoporosis.

Methods: This retrospective study used a nationally representative 5% sample of Medicare fee-for-service beneficiaries from CMS (2017-2022). Diagnostic trends for sarcopenia and osteoporosis were compared. Nonlinear regression was used to assess the temporal association of the number of beneficiaries with an abdominal CT and a sarcopenia diagnosis (compared with dual-energy x-ray absorptiometry and osteoporosis diagnosis). Multivariable logistic regression models controlling for gender, age, race or ethnicity, urbanicity, area deprivation, and comorbidities assessed the likelihood of imaging associated with the diagnosis.

Results: For 11,801,012 beneficiary years, there were 2,849,547 unique beneficiaries (53.2% female). Beneficiaries diagnosed with sarcopenia increased 480% from 0.01% in 2017 to 0.07% in 2022. From 90 days before the diagnosis date, the number of beneficiaries with an abdominal CT scan increased from the baseline rate at an exponential rate. After the diagnosis, the number of beneficiaries with abdominal CT scans was also elevated and returned to the baseline rate by 90 days after the diagnosis. These nonlinear patterns are statistically different from the null hypothesis of a flat line, which is indicative of no temporal association.

Conclusion: Although the diagnostic rate for sarcopenia increased nearly 5-fold from 2017 to 2022, it remains underdiagnosed. The results provide evidence that abdominal CT (used opportunistically or intentionally) may contribute to diagnosing sarcopenia.