Objective: To explore use of bone densitometry in Australia and to identify any sex and geographic differences, as a marker of osteoporosis diagnosis and care. Design and setting: Analysis of claims data from Medicare Australia in patients aged over 45 years during the period 2001-2005. Main outcome measures: Age-standardised rates of bone densitometry use, by sex and by metropolitan, rural or remote classification. Results: Bone densitometry use increased by 26% over the 5 years. Rates were lower for rural and remote populations, with people in capital cities about three times as likely to undergo the investigation as those in remote areas. The sex ratio for the rate of bone densitometry use (women to men) decreased from more than 6 : 1 in 2001 to 4 : 1 in 2005. Conclusion: Although the sex ratio for osteoporotic fracture is close to 2: 1 (women to men), the sex ratio for testing is much higher, suggesting underuse of bone densitometry in men. Sex and rural inequities in use of the investigation need to be addressed as part of a national approach to reducing minimal trauma fracture.