At what age is DEXA (Dual-Energy X-ray Absorptiometry) screening recommended to start?

DEXA Screening Age Recommendations

DEXA screening should begin at age 65 for all women and age 70 for all men without risk factors, while those with specific risk factors should be screened earlier regardless of age. 1

Standard Screening Ages

The most recent guidelines provide clear recommendations for when to initiate DEXA screening:

• Women age 65 and older: Routine screening recommended 1
• Men age 70 and older: Routine screening recommended 1

Risk-Based Screening for Younger Adults

For adults younger than the standard screening ages, DEXA is recommended only in the presence of specific risk factors:

For Postmenopausal Women Under 65:

• Prior fracture
• Low body weight
• High-risk medication use (e.g., glucocorticoids, anticonvulsants)
• Medical conditions associated with bone loss 2

For Men Ages 50-69:

• Only with clinical risk factors for low bone mass 2

Specific High-Risk Groups Requiring Earlier Screening

DEXA is recommended regardless of age for individuals with:

• Previous fracture
• Chronic glucocorticoid use (≥5 mg prednisone daily for ≥3 months) 1
• Spinal cord injuries (as soon as medically stable) 1
• Androgen deprivation therapy for prostate cancer 1
• Hyperparathyroidism, hyperthyroidism, or Cushing syndrome 1
• Gastric bypass surgery 1
• Long-term therapy with medications known to adversely affect BMD 1

Clinical Decision Algorithm

1. Determine patient age and sex

   • Women ≥65 years or men ≥70 years → Proceed with DEXA
   • Younger → Continue to step 2

2. Assess for risk factors

   • Postmenopausal status (women)
   • Previous fracture
   • Chronic glucocorticoid use
   • Endocrine disorders affecting bone
   • Low body weight
   • Family history of osteoporosis
   • Early menopause or hypogonadism
   • Medications affecting bone density
   • If ANY risk factors present → Proceed with DEXA
   • If NO risk factors → Routine screening at standard age

Important Considerations and Pitfalls

• Avoid unnecessary early screening: Research shows osteoporosis is infrequent in women with distal forearm fractures below age 65, suggesting limited value in routine screening before this age 3

• Two-step approach for younger postmenopausal women: Consider fracture risk assessment tools first, followed by DEXA only for those identified as high risk 1

• Special populations: Transgender individuals require individualized approaches based on hormone therapy status and gonadal removal 1

• Technical limitations: DXA scans are two-dimensional projections that may underestimate true bone density in short individuals or overestimate it in tall individuals 1

• Avoid scanning areas with artifacts: Hip prostheses, severe degenerative changes, or previous fractures can affect accuracy 1

The evidence strongly supports a risk-stratified approach to DEXA screening, with universal screening beginning at age 65 for women and 70 for men, and earlier screening only for those with specific risk factors that significantly increase fracture risk.