From the Guidelines
For a 69-year-old female patient with a T-score of -1.7 who is not at increased risk of fracture based on the FRAX tool, bone density screening should be repeated in 5 years. This recommendation is based on the most recent evidence from the US Preventive Services Task Force recommendation statement published in JAMA in 2025 1, which suggests that repeating BMD testing at an interval of 4 to 8 years does not result in additional accuracy in predicting fractures. Given the patient's T-score and age, a 5-year interval is reasonable, as studies have shown that transition to osteoporosis occurs over shorter intervals for individuals with lower baseline T scores and older age, but still falls within the suggested range of 4 to 8 years. Key considerations for this patient include:
- Maintaining adequate calcium intake (1000-1200 mg daily) and vitamin D supplementation (800-1000 IU daily)
- Engaging in weight-bearing exercise
- Avoiding smoking
- Limiting alcohol consumption to reduce fracture risk If the patient develops new risk factors such as corticosteroid use, falls, fractures, or certain medical conditions that accelerate bone loss, earlier reassessment would be warranted. The goal of this monitoring schedule is to detect any significant progression toward osteoporosis that might necessitate pharmacologic intervention before a fracture occurs, as suggested by the study published in JAMA in 2025 1.
From the Research
Bone Density Screening Interval
The appropriate interval for the next bone density screening in a 69-year-old female patient with a T-score of -1.7, using the Fracture Risk Assessment (FRAX) tool, and not at increased risk of fracture, can be determined based on general guidelines for bone density testing.
- The National Osteoporosis Foundation recommends that women with a T-score between -1.0 and -2.5 should have a follow-up bone density test every 2 to 5 years, depending on the initial results and the presence of other risk factors 2.
- However, the provided studies do not specify the exact interval for a patient with a T-score of -1.7, but they do emphasize the importance of using FRAX to assess fracture risk and guide treatment decisions 3, 4, 5, 2, 6.
- Given the patient's T-score and the fact that she is not at increased risk of fracture, a reasonable approach would be to follow the general guidelines for bone density testing intervals.
- Possible intervals for the next screening could be:
- 2 years: This interval may be appropriate if the patient has other risk factors for fracture or if her bone density is decreasing rapidly.
- 5 years: This interval may be suitable if the patient's bone density is stable and she has no other risk factors for fracture.
- 3 years: Although not explicitly mentioned in the studies, this interval could be considered as a middle ground between 2 and 5 years, depending on the patient's individual circumstances.
It is essential to note that the decision on the exact interval for the next bone density screening should be made on a case-by-case basis, taking into account the patient's overall health, medical history, and other risk factors for fracture.