MON-799 Differences by Sex in the Incidence of Hip Fractures and the Performance of DXA Exams in Brazil: A Population Analysis (2008-2022)

Abstract Disclosure: I.C. Silva: None. B. Albergaria: None. B.C. Teixeira: None. M. Ohe: None. M. Lazaretti-Castro: None. Although osteoporosis mainly affects women, around a third of hip fractures occur in men, who have higher post-fracture mortality. Hip fractures are projected to rise in the coming decades, with studies suggesting a steeper increase in men. Despite guidelines recommending DXA screening for men ≥70 and women ≥65, adherence in Brazil remains unknown. This study analyzed trends in hip fracture incidence and DXA utilization from 2008 to 2022 among individuals covered by the Brazilian Unified Health System (SUS) to identify potential disparities in osteoporosis screening. Methods: We conducted a retrospective, population-based study using the Department of Informatics of SUS (DATASUS) data on hip fractures and DXA exams, stratified by age and sex. Incidence rates were calculated per 100,000 individuals aged ≥50, with subgroup analyses for men ≥70 and women ≥65. Data were further stratified into five-year age intervals, and median fracture age was determined by sex. To assess trends, we used the auto.arima function in R, projecting incidence rates for 2015-2022 based on 2008-2014 data and comparing predictions with observed values. Results: Between 2008 and 2022, the annual incidence of hip fractures was 79 per 100,000 men and 132 per 100,000 women. In 2022, rates increased to 94 in men and 155 in women; among those ≥70 years (men) and ≥65 years (women), rates were 255 and 354 per 100,000, respectively. The median fracture age was 74 years (IQR = 63-82) in men and 80 (IQR = 72-86) in women. The total number of hip fractures increased by 28% from 2008 to 2015 and 53% from 2015 to 2022. A fracture decline in 2020 coincided with the COVID-19 pandemic, followed by recovery in 2021 and 2022. The early increase in the absolute number of hip fractures aligned with population aging, but the post-2015 trend indicates an actual rise in incidence rates. From 2008 to 2022, the DXA incidence rate per 100,000 was 148 for men and 2,092 for women. In 2022, rates were 182 for men and 2,177 for women. Among men ≥70 years and women ≥65, the rates were 304 and 2,494 per 100,000, respectively. DXA exams increased from 2008 to 2014 but stagnated afterward, with a sharp 32% decline in 2020, reflecting the pandemic's disruption of osteoporosis screening, with a partial recovery in 2022. The male-to-female fracture rate ratio was 6:10, whereas DXA testing was significantly lower in men, with a ratio of 1:10. Discussion and conclusion: Despite the increasing burden of hip fractures, DXA utilization has not followed this trend, especially in men, who fracture at younger ages yet remain underdiagnosed. DXA screening rates are significantly lower in men 70 and older, even though guidelines recommend routine screening for this group. The findings reinforce the need for public policies to expand osteoporosis screening, especially in men, including primary prevention programs and post-fracture follow-up. Presentation: Monday, July 14, 2025