Government-Implemented population osteoporosis screening in rural china: achieving universal coverage with portable DXA.

BACKGROUND: China's rural elderly population (projected to reach 190 million by 2035) faces a high osteoporosis (OP) burden, with national sampling surveys reporting a 26.8% prevalence (95% CI: 25.1%-28.5%) in rural adults ≥60 years (Zeng, Li, Wang, et al., Arch Osteoporos 14:39-48, 2019). However, screening gaps persist due to limited central DXA access (< 1 unit/100,000 older adults) and poor sensitivity of quantitative ultrasound (QUS; <60% for asymptomatic OP). This study evaluated a novel government-led model using portable DXA (pDXA) to achieve universal screening coverage in rural China. METHODS: A STROBE-compliant cross-sectional study (June-November 2021) enrolled all eligible permanent residents ≥ 60 years (N = 3,530) in Tongcun Community, Wujiang District, Jiangsu. pDXA (Dexa Pro-I, Xuzhou Pinyuan; National Medical Products Administration Reg. No. 20182061513) was integrated into annual health exams at Tongcun Community Health Center. Certified radiographers performed nondominant forearm scans (diagnostic threshold per WHO criteria: T score ≤-2.5), and OP specialists (≥ 8 years of experience) from Suzhou Ninth Hospital provided patient education. Multivariable logistic regression and propensity score matching (covariates: age, gender, daily exercise duration, prior fracture history) adjusted for confounders. RESULTS: • Overall OP prevalence: 38.2% (95% CI: 36.7-39.7), with significant gender disparity (women: 55.4% [95% CI: 53.2-57.6]; men: 18.0% [95% CI: 16.1-20.0]; χ² test, p < 0.001) • Age-stratified female OP prevalence: 41.2% (60-69 y), 62.1% (70-79 y), 73.6% (≥80 y). • Cost per screen: ​​¥6.2, 87% lower than central DXA (¥48.5/screen (Li, Zhang, Wang, et al., J Rural Health 37(2):189-196, 2021)). Treatment initiation rate: 21.0%; key barriers included "perceived no symptoms" (68.1% overall; higher in men: 72.3% vs women: 66.4%; p=0.02) and "medication cost concerns" [72.3% overall; 89.1% in groups with low medical payment capacity (defined by OP awareness, health consciousness, and treatment spending willingness) ]. CONCLUSIONS: Government-procured pDXA enables cost-effective universal OP screening in resource-limited rural areas. Scaling this model requires culturally adapted education (e.g., Wu Chinese dialect audiovisual materials) and tiered medication subsidies for groups with low medical payment capacity, aligning with the UN Decade of Healthy Aging (United Nations, UN Decade of Healthy Aging 2021-2030, World Health Organization, 2020).