Government-Implemented Population Osteoporosis Screening in Rural China: Achieving Universal Coverage with Portable DXA

Abstract Background​​: China's aging rural population faces a 30% prevalence of osteoporosis (OP), yet screening gaps persist owing to limited DXA access (<1 unit/100,000 older adults). Quantitative ultrasound (QUS) has poor sensitivity (<60%) and selection bias. This study evaluated a novel government-executed model using portable DXA (pDXA) for universal coverage. ​​Methods​​: A cross-sectional study (2021) enrolled ​​all​​ eligible permanent residents ≥60 years (N=3,530) in Tongcun Community, Jiangsu. pDXA (Dexa Pro-I, Xuzhou Pinyuan) was integrated into annual health exams at ​​Tongcun Community Health Center​​. Certified radiographers performed the scans (nondominant forearm; T score≤-2.5), whereas OP specialists from Suzhou Ninth Hospital conducted the education. Multivariable regression and propensity score matching adjusted for confounders. ​​Results​​ · OP incidence: ​​38.2%​​ (women: 55.4% vs men: 18.0%; aOR=4.15, 95% CI: 3.42--5.04) · Age-stratified female OP: 41.2% (60--69 y), 62.1% (70--79 y), ​​73.6%​​(≥80 y) · Cost per screen: ​​¥6.2​​ (87% lower than central DXA) · Treatment initiation: ​​21.0%​​ (barriers: "no symptoms" [68.1%], cost concerns [72.3% in low-income residents]) Conclusions:​​ Government-procured pDXA enables cost-effective population screening in resource-limited areas. Addressing ​​gender-specific health literacy gaps​​ through culturally adapted interventions is critical for scaling.