At what age should bone density screening start?

From the Guidelines

Bone density screening should start at age 65 for women and age 70 for men with no risk factors, as recommended by the latest guidelines from the US Preventive Services Task Force 1. This recommendation is based on the most recent and highest quality study, which suggests that screening for osteoporosis via DXA measurement of BMD in older adults can help prevent fractures. The American College of Obstetricians and Gynecologists guidelines also recommend BMD screening with DXA beginning at age 65 years in all women and selective screening with BMD in women younger than 65 years who have an elevated risk of osteoporosis based on a formal clinical risk assessment tool 1. Some key points to consider when deciding on the age for bone density screening include:

• The risk of osteoporosis and fractures increases with age, making it essential to screen older adults regularly 1.
• Individuals with risk factors such as early menopause, low body weight, family history of osteoporosis, certain medications (like long-term corticosteroids), or medical conditions that affect bone health may need to be screened earlier 1.
• The screening, called a dual-energy X-ray absorptiometry (DEXA) scan, measures bone mineral density to assess fracture risk and detect osteoporosis before fractures occur.
• Early detection and intervention can significantly reduce fracture risk, and follow-up tests are typically recommended every 2-5 years depending on results and risk factors.

From the Research

Age for Screening Bone Density

• The recommended age for bone density screening varies based on gender and risk factors 2, 3.
• For women, bone density screening is recommended at age 65 and older, or postmenopausal women under 65 with risk factors such as low body weight, prior fracture, or high-risk medication use 2, 3.
• For men, bone density screening is recommended at age 70 and older 2, 3.
• Individuals with a history of fragility fracture, or those taking medications or having conditions associated with low bone mass or bone loss, should also undergo bone density screening regardless of age 3.

Screening Intervals

• The interval between bone density tests depends on the individual's bone density and risk factors 4.
• For women with normal bone density, a screening interval of approximately 15 years is recommended 4.
• For women with osteopenia, the screening interval ranges from 1 to 17 years, depending on the severity of osteopenia 4.

Measurement Techniques

• Dual-energy X-ray absorptiometry (DXA) is the method of choice for assessing bone density 2, 3, 5.
• Peripheral DXA of the calcaneus can be used to diagnose low bone mass, especially in women over 65 years old 5.