Should an 83-year-old female with risk factors for osteoporosis have a Dual-Energy X-ray Absorptiometry (DEXA) scan?

From the Guidelines

Yes, an 83-year-old female with risk factors for osteoporosis should have a DEXA scan. This recommendation is based on the guidelines that suggest routine screening for osteoporosis in women 65 years of age and older, regardless of risk factors 1. The DEXA scan is a crucial tool for measuring bone mineral density and determining fracture risk, which is particularly important for elderly patients with existing risk factors.

Importance of DEXA Scan

The DEXA scan results, reported as T-scores, help guide treatment decisions. Generally, treatment is recommended for T-scores of -2.5 or lower, or for scores between -1.0 and -2.5 with significant fracture risk. Early detection and treatment are crucial as osteoporotic fractures in elderly patients can lead to significant morbidity, loss of independence, and increased mortality.

Treatment Options

Based on the results of the DEXA scan, appropriate treatment can be initiated, which might include medications such as:

• Bisphosphonates (alendronate 70mg weekly, risedronate 35mg weekly, or zoledronic acid 5mg IV yearly)
• Denosumab (60mg subcutaneously every 6 months)
• Teriparatide or abaloparatide (for severe osteoporosis) Treatment would typically be accompanied by calcium supplementation (1000-1200mg daily) and vitamin D (800-1000 IU daily) 1.

Clinical Considerations

While there are no specific data on the appropriate age to stop screening, the benefits of screening and treatment for osteoporosis in women at increased risk by virtue of age or presence of other risk factors are considered to be of at least moderate magnitude 1. Therefore, screening for osteoporosis in an 83-year-old female with risk factors is recommended.

From the Research

DEXA Scan for 83-Year-Old Female

• The decision to perform a Dual-Energy X-ray Absorptiometry (DEXA) scan on an 83-year-old female with risk factors for osteoporosis should be based on clinical risk factors and the potential benefit of the scan in guiding treatment decisions 2.
• According to the study published in The Practitioner, DEXA scans should be considered if the 10-year risk of major osteoporotic fracture is > 10% 2.
• The same study suggests that if the BMD T-score values by DEXA at the lumbar spine, femoral neck, or total hip are at or below -2.5, the diagnosis of osteoporosis is confirmed 2.
• However, it is also noted that in patients aged above 65, the vast majority will have a T-score of -1.5 or below, and a DEXA scan may not be absolutely necessary to initiate bone protective therapy 2.
• Other studies have evaluated the role of DEXA scans in osteoporosis screening, including a study published in Family medicine, which found that peripheral DEXA measurements can be useful in screening patients at risk for osteoporosis 3.
• Another study published in Family practice estimated that the unmet need for DEXA scans in women at high risk for osteoporosis is approximately 180 per 10,000 total practice population 4.
• A case study published in Australian family physician highlighted the importance of vitamin D deficiency in osteoporotic fractures and the use of DEXA scans in assessing osteoporosis 5.
• A study published in Maturitas compared the role of quantitative ultrasonography (QUS) and DEXA in the assessment of osteoporosis in postmenopausal women, suggesting that QUS may be more suitable for younger postmenopausal women 6.

Risk Factors and DEXA Scan

• The presence of risk factors such as increasing age and female gender, as well as other factors like long-term corticosteroid therapy, chronic inflammatory disease, malabsorption, and untreated premature menopause, should be considered when deciding whether to perform a DEXA scan 2.
• The study published in The Practitioner notes that vertebral fractures are generally taken as diagnostic of osteoporosis, even if spine BMD values are not in the osteoporotic range 2.

Treatment and DEXA Scan

• The decision to initiate bone protective therapy should be based on clinical risk factors and the results of the DEXA scan, if performed 2.
• Oral bisphosphonates are the first-line treatment for osteoporosis, and parenteral therapy should be considered if oral bisphosphonates are contraindicated or not tolerated 2.