From the Guidelines
The recommended frequency for Dual-Energy X-ray Absorptiometry (DEXA) scans is every 1-5 years, depending on the patient's clinical state and risk factors, with more frequent monitoring every 1-2 years for those with osteoporosis, on osteoporosis medication therapy, or with secondary causes of bone loss. The frequency of DEXA scans should be individualized based on the rate of bone loss, fracture risk, and treatment decisions 1. For most patients, a follow-up interval of 1-2 years is recommended after starting or changing therapy, while less frequent testing may be reasonable for patients with stable bone density measurements over time 1.
Key Considerations for DEXA Scan Frequency
- Patients with moderate to severe osteopenia (T-score between -1.5 and -2.5) should undergo testing every 1-2 years 1
- Patients with secondary causes of bone loss, such as those on long-term glucocorticoid therapy, hyperparathyroidism, or malabsorption disorders, may require annual scans 1
- The frequency of BMD testing may be influenced by the patient's clinical state, national clinical guidelines, cost, and reimbursement 1
- Follow-up of patients should ideally be conducted in the same facility with the same DXA system, if the acquisition, analysis, and interpretation adhere to recommended standards 1
Special Considerations
- Premenopausal women and men under 50 years with specific diseases, medical drugs, or fracture may require DEXA scans, with follow-up intervals based on underlying clinical conditions 1
- Patients with primary and secondary hyperparathyroidism should undergo DEXA scans every 1-2 years, as well as undergo a parathyroidectomy if T-scores are -2.5 or lower at any measured site 1
From the Research
DEXA Scan Frequency
The recommended frequency for Dual-Energy X-ray Absorptiometry (DEXA) scans in patients with varying risks of osteoporosis is not explicitly stated in the provided studies. However, the following points can be considered:
- DEXA scans should be considered if the 10-year risk of major osteoporotic fracture is > 10% 2.
- The diagnosis of osteoporosis can be confirmed by DEXA if the BMD T-score values at the lumbar spine, femoral neck, or total hip are at or below -2.5 2.
- Vertebral fractures are generally taken as diagnostic of osteoporosis, even if spine BMD values are not in the osteoporotic range 2.
- DEXA scans can be useful in determining if bone protective treatment is needed immediately or if it could be delayed until the T score falls below -1.5, especially in younger individuals 2.
Risk Factors and DEXA Scans
Some key points to consider regarding risk factors and DEXA scans are:
- Increasing age and female gender are two of the most important risk factors for osteoporosis 2.
- Other common and potentially modifiable risk factors include long-term corticosteroid therapy, chronic inflammatory disease, malabsorption, and untreated premature menopause 2.
- A screening strategy that concentrates on women at 'high risk' can help identify those who might benefit from treatment or prophylaxis for osteoporosis 3.
Treatment and DEXA Scans
The following points can be considered regarding treatment and DEXA scans:
- Oral bisphosphonates are the first-line treatment for osteoporosis, but denosumab can be considered in patients with impaired renal function or those who cannot tolerate bisphosphonates 4.
- Denosumab has been shown to increase BMD more than bisphosphonates at 12 and 24 months, but the difference in fracture risk reduction is not significant 5.
- Switching to denosumab or bisphosphonates after completion of teriparatide treatment can help maintain or increase BMD in postmenopausal women with severe osteoporosis 6.