From the Guidelines
A DEXA scan is typically recommended for women at age 65 and older and men at age 70 and older, as stated in the most recent guidelines 1. However, earlier screening may be appropriate for individuals with risk factors for osteoporosis, including early menopause, low body weight, family history of osteoporosis, certain medications (such as long-term corticosteroids), smoking, excessive alcohol consumption, or previous fractures. The scan is important because it measures bone mineral density to assess for osteoporosis and fracture risk before symptoms occur. Some key points to consider when deciding to start a DEXA scan include:
- Age: women ≥ 65 years, men ≥ 70 years 1
- Risk factors: early menopause, low body weight, family history of osteoporosis, certain medications, smoking, excessive alcohol consumption, or previous fractures 1
- Medical conditions: chronic glucocorticoid use, androgen deprivation therapy, and spinal cord injury 1
- The test is quick, painless, uses minimal radiation, and requires no special preparation beyond removing metal objects from the scan area. It's also important to note that the frequency of BMD testing in clinical practice may be influenced by the patient’s clinical state, national clinical guidelines, cost and reimbursement, with suggested intervals between BMD testing typically ranging from 1-5 years after starting or changing therapy 1.
From the Research
DEXA Scan Recommendations
- A Dual-Energy X-ray Absorptiometry (DEXA) scan is typically recommended for women 65 years and older and men 70 years and older to assess fracture risk 2.
- For postmenopausal women younger than 65 years and men 50-69 years, DEXA scans are recommended only in the presence of clinical risk factors for low bone mass, such as low body weight, prior fracture, high-risk medication use, or a disease or condition associated with bone loss 2.
- There is no specific age recommendation for DEXA scans in the general population, but it is often used to diagnose and monitor osteoporosis in individuals with risk factors or symptoms 3, 4, 5.
Special Considerations
- For individuals with glucocorticoid-induced osteoporosis, DEXA scans may underestimate the risk of fracture, and clinical assessment should consider multiple factors 4.
- In cases of thalassemia-associated osteoporosis, a multidisciplinary approach is crucial, and treatment choices may be guided by clinical experience and center resources due to limited evidence 6.