What are the screening guidelines for Dual-Energy X-ray Absorptiometry (Dexa) scans for osteoporosis?

From the Guidelines

Dual-Energy X-ray Absorptiometry (DEXA) scans for osteoporosis screening are recommended for all women aged 65 and older and men aged 70 and older, as well as for younger individuals with risk factors such as low body weight, family history of osteoporosis, smoking, excessive alcohol consumption, long-term steroid use, rheumatoid arthritis, early menopause, or previous fragility fractures. The screening guidelines for DEXA scans are based on the latest evidence from high-quality studies, including 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.

According to this guideline, DXA BMD measurement should be performed at the lumbar spine, total hip, femoral neck, and, if indicated, one-third radius. The guideline also recommends considering DXA in all women at the age of 65 years or older, men aged 70 years or older, and women and men aged 50 years or older with risk factors for osteoporosis.

The American College of Radiology Appropriateness Criteria also support the use of DXA for osteoporosis screening, particularly in postmenopausal women and men with risk factors for fracture 1. Additionally, the US Preventive Services Task Force recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years or older and in postmenopausal women younger than 65 years who are at increased risk of osteoporosis 1.

Some key points to consider when interpreting DXA results include:

• The World Health Organization's definition of osteoporosis as a T-score of -2.5 or lower in the lumbar spine, femoral neck, total hip, or one-third radius 1
• The use of T-scores to compare bone density to young healthy adults, with scores below -2.5 indicating osteoporosis 1
• The importance of considering risk factors such as family history, smoking, and long-term steroid use when interpreting DXA results 1
• The role of DXA in monitoring treatment effectiveness and fracture risk reduction 1

Overall, the evidence supports the use of DXA scans as a valuable tool for osteoporosis screening and monitoring, particularly in individuals with risk factors for fracture. The recommendation for DEXA scans is based on the latest evidence from high-quality studies, and it is essential to consider the individual's risk factors and medical history when interpreting the results.

From the Research

Screening Guidelines for Dexa Scans

The screening guidelines for Dual-Energy X-ray Absorptiometry (Dexa) scans for osteoporosis are as follows:

• Dexa scans should be considered for patients who have an increased risk of fracture on the basis of clinical risk factors, such as increasing age and female gender 2.
• The diagnosis of osteoporosis can be confirmed by Dexa scan if the 10-year risk of major osteoporotic fracture is > 10% 2.
• Dexa scans should be performed if the BMD T-score values at the lumbar spine, femoral neck, or total hip are at or below -2.5, which confirms the diagnosis of osteoporosis 2.
• Vertebral fractures are generally taken as diagnostic of osteoporosis, even if spine BMD values are not in the osteoporotic range 2.

Rescreening Intervals

The rescreening intervals for Dexa scans are:

• Approximately 15 years for women with normal bone density or mild osteopenia 3.
• 5 years for women with moderate osteopenia 3.
• 1 year for women with advanced osteopenia 3.

Treatment and Monitoring

• Patients with osteoporosis should be treated with pharmacologic therapy, such as oral bisphosphonates, if they have a FRAX-calculated 10-y probability of at least 3% for hip fracture or at least 20% for major osteoporotic fracture 4.
• Patients who are treated for osteoporosis should be monitored regularly to track expected gains in BMD by serial Dexa scans 4.

Alternative Screening Methods

• Peripheral Dexa (p-Dexa) heel bone mineral density (BMD) measurement can be used as a screening tool for osteoporosis, especially in primary care settings 5.
• Computed Tomography (CT) scans can also be used for opportunistic screening of osteoporosis, with Hounsfield units (HU) values correlated with BMD and T-scores measured by Dexa scans 6.