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Hip fracture incidence increased over time, whereas DXA use, particularly among men, remained markedly lower, with substantial disparities in device availability between the public and private sectors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>We aimed to evaluate temporal trends in hip fracture incidence and DXA exam utilization in Brazil, stratified by sex, and to assess DXA device distribution across public and private healthcare sectors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective analysis of Brazilian public healthcare databases from January 1, 2008, to December 31, 2022, examining hip fracture hospitalizations, DXA exam utilization, and DXA device availability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 2008 to 2022, 583,205 hip fractures occurred in individuals\u2009\u2265\u200950\u00a0years living in Brazil. In 2022, incidence rates were 155\/100,000 in women and 94\/100,000 in men; median ages were 80 and 74\u00a0years, respectively. Hip fracture incidence increased by 25.8%, with a more pronounced rise after 2015. DXA rates in 2022 were 2177\/100,000 in women and 182\/100,000 in men\u2009\u2265\u200950; in guideline-recommended groups, 2840\/100,000 in women\u2009\u2265\u200965 and 385\/100,000 in men\u2009\u2265\u200970. The hip fracture ratio between men and women was\u2009~\u20092:3, whereas the DXA exam ratio was 1:10. DXA device availability was 12.2 per million inhabitants overall, with 6.2 in the public sector versus 27 in the private sector.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hip fracture incidence in Brazil increased over the study period, particularly after 2015, without a proportional expansion in DXA utilization. This mismatch is more pronounced in men, who experience a substantial fracture burden but remain markedly underscreened. These findings highlight structural inequities in access to osteoporosis diagnosis and suggest persistent underdiagnosis, particularly in the public healthcare system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11657-026-01734-5","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:28:46Z","timestamp":1787750926000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sex-specific trends in hip fracture incidence and disparities in DXA utilization in Brazil: a nationwide ecological analysis"],"prefix":"10.1007","volume":"21","author":[{"given":"Isabela","family":"Janu\u00e1rio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben-Hur","family":"Albergaria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno Casaes","family":"Teixeira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marise","family":"Lazaretti-Castro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"1734_CR1","first-page":"739","volume":"66","author":"L Bandeira","year":"2022","unstructured":"Bandeira L, Silva BC, Bilezikian JP (2022) Male osteoporosis. 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