What are the guidelines for Dexa (Dual-Energy X-ray Absorptiometry) scans in patients at risk of osteoporosis?

From the Guidelines

DEXA scans are recommended for all women at the age ≥ 65 years, men age > 70 years, and women and men age ≥ 50 years with risk factors for osteoporosis. According to the updated practice guideline for dual-energy x-ray absorptiometry (DXA) published in the European Journal of Nuclear Medicine and Molecular Imaging in 2025 1, DXA BMD measurement should be performed at the lumbar spine, total hip, femoral neck, and, if indicated, one-third radius.

Key Points for DEXA Scans

• Consider DXA in younger adults (premenopausal women and men under 50 years) with specific diseases, and/or medical drugs and/or fracture 1.
• Evaluate for prevalent vertebral fractures with VFA or standard radiography in patients ≥ 50 years with specific risk factors, or with a T-score < -1.0 in older men and women, historical height loss > 4 cm, self-reported but undocumented vertebral fracture, or long-term glucocorticoid therapy 1.
• Osteoporosis is diagnosed based on a T-score of − 2.5 or lower in the lumbar spine, femoral neck, total hip, or one-third radius, with the lowest T-score at any of these measured sites used for diagnosis 1.

Follow-Up and Certification

• Follow-up DXA scans are recommended as indicated, depending on clinical circumstances, with suggested intervals between BMD testing typically 1–5 years after starting or changing therapy 1.
• Procedural certification and repeated audits are recommended to ensure high-quality DXA scans 1.

From the Research

Dexa Guidelines

• The diagnosis of osteoporosis can be confirmed by DEXA, but this should only be performed in patients who have an increased risk of fracture on the basis of clinical risk factors 2.
• DEXA should be considered if the 10-year risk of major osteoporotic fracture is > 10% 2.
• If the BMD T-score values by DEXA at the lumbar spine, femoral neck or total hip are at or below -2.5, then the diagnosis of osteoporosis is confirmed 2.
• Vertebral fractures are generally taken as diagnostic of osteoporosis, even if spine BMD values are not in the osteoporotic range 2.

Indications for Dexa Scan

• Patients with an increased risk of fracture on the basis of clinical risk factors, such as increasing age and female gender 2.
• Patients with a 10-year risk of major osteoporotic fracture > 10% 2.
• Patients with a BMD T-score of <-1.5, especially those with glucocorticoid-induced osteoporosis 2.
• Patients who have undergone a DEXA scan before starting treatment to provide a baseline value to assess response 2.

Alternative Methods for Bone Density Assessment

• Computed Tomography (CT) scans can be used for opportunistic screening of osteoporosis, especially in patients undergoing routine CT abdomen or lumbar spine scans 3.
• CT scans can provide information about a patient's bone density, and Hounsfield units (HU) values can be used to screen for osteoporosis 3.
• Peripheral DEXA (p-DEXA) measurements can be used for osteoporosis screening, especially in primary care settings 4.

Treatment and Management

• Oral bisphosphonates are the first-line treatment for osteoporosis 2.
• Parenteral therapy should be considered if oral bisphosphonates are contraindicated or not tolerated 2.
• Alendronate treatment has been shown to improve bone mineral density in men with osteoporosis 5.