DEXA Scan Age Recommendations
DEXA scans should be performed in all women aged 65 years and older and men aged 70 years and older for routine osteoporosis screening, while younger individuals should only undergo testing if they have specific risk factors for bone loss. 1
Standard Age-Based Recommendations
Women:
- Age 65 and older: Routine DEXA screening recommended for all women 1
- Under age 65: Selective screening only for those with risk factors 1
Men:
- Age 70 and older: Routine DEXA screening recommended 1
- Ages 50-69: Selective screening only for those with risk factors 1
Risk Factors Warranting Earlier DEXA Screening
For postmenopausal women younger than 65 and men aged 50-69, DEXA should be performed if any of these risk factors are present:
- Previous fragility fracture 1
- Low body weight (less than 127 lb/58 kg) 1
- Parental history of hip fracture 1
- Long-term glucocorticoid therapy (≥5 mg prednisone daily for ≥3 months) 1
- Chronic inflammatory conditions (e.g., rheumatoid arthritis) 1
- Conditions causing malabsorption or malnutrition 1
- Untreated premature menopause or hypogonadism 1
- Organ transplantation 1
- Prolonged immobilization 1
- Endocrine disorders affecting bone (hyperparathyroidism, hyperthyroidism, Cushing syndrome) 1
- Medications known to cause bone loss (anticonvulsants, androgen deprivation therapy, aromatase inhibitors, chronic heparin) 1
Special Populations
Spinal Cord Injury Patients
- DEXA scan recommended as soon as medically stable, regardless of age 1
- Should include total hip, proximal tibia, and distal femur measurements 1
Transgender Individuals
- Screening based on hormone therapy compliance, gonadal removal, and additional risk factors 1
- Z-scores should be calculated using reference data conforming with the individual's gender identity 1
Follow-up Intervals
- High risk for accelerated bone loss: Every 1-2 years 1
- Standard risk with risk factors present: Every 2 years 1
Clinical Pitfalls to Avoid
Waiting until age 65 for all women: Evidence shows that women with distal forearm fractures below age 65 infrequently have osteoporosis (only 21.1% with T-score <-2.5), making routine DEXA scanning before age 65 unnecessary unless risk factors are present 2.
Relying solely on central DEXA in fracture risk assessment: For elderly females at risk of distal radius fracture, distal forearm DEXA may provide better prediction than central DEXA alone 3.
Using body weight alone to predict low BMD: This is an unreliable predictor (area under ROC curve only 70%) 2.
Overlooking degenerative changes: In patients over 50 with advanced degenerative changes of the spine, these changes may spuriously elevate BMD values, requiring careful image inspection 1.
By following these evidence-based recommendations, clinicians can appropriately identify patients who would benefit from DEXA scanning while avoiding unnecessary testing in low-risk individuals.