At what age does osteoporosis screening typically start?

Osteoporosis Screening Recommendations by Age and Risk Factors

Osteoporosis screening should begin at age 65 for all women and age 70 for all men, with earlier screening for those with significant risk factors. 1, 2

Standard Screening Recommendations

For Women:

• Age 65 and older: Universal screening recommended 1, 2
• Ages 60-64: Screen if increased risk for osteoporotic fractures 1
• Ages 50-59: No routine screening unless significant risk factors present 1

For Men:

• Age 70 and older: Routine screening recommended 1, 2
• Ages 50-69: Screen only if risk factors present 1

Risk Factors That Warrant Earlier Screening

Screening should begin earlier for individuals with risk factors that significantly increase fracture risk:

• Previous fragility fracture
• Low body weight (< 70 kg)
• Parental history of hip fracture
• Long-term glucocorticoid therapy
• Current smoking
• Excessive alcohol consumption
• Chronic inflammatory conditions
• Conditions causing malabsorption or malnutrition
• Premature menopause or hypogonadism
• Prolonged immobilization
• Endocrine disorders affecting bone health 1, 2

Special Populations Requiring Screening

• Cancer patients: Those receiving therapies affecting bone health (e.g., aromatase inhibitors for breast cancer, androgen deprivation therapy for prostate cancer) 2
• Chronic kidney disease patients: Those with additional risk factors for fracture 2

Screening Methods

The gold standard for osteoporosis screening is dual-energy x-ray absorptiometry (DEXA) measuring bone mineral density (BMD) at the following sites:

• Femoral neck (best predictor of hip fracture)
• Total hip
• Posteroanterior spine 2

Diagnostic Criteria

According to WHO criteria:

• Osteoporosis: T-score ≤ -2.5
• Osteopenia: T-score between -1.0 and -2.5
• Normal: T-score ≥ -1.0 2

Screening Intervals

• Standard risk individuals: Every 2 years
• High-risk individuals: Every 1-2 years
• Patients on medications affecting bone density (e.g., glucocorticoids): Annual screening 2

Risk Assessment Tools

For individuals younger than the standard screening age, risk assessment tools can help determine the need for screening:

• FRAX tool: The USPSTF recommends screening women whose 10-year fracture risk is equal to or greater than that of a 65-year-old white woman without additional risk factors (9.3% 10-year risk) 1
• Osteoporosis Risk Assessment Instrument (ORAI): Incorporates age, weight, and estrogen use 1

Common Pitfalls in Osteoporosis Screening

1. Underscreening: Despite recommendations, screening rates remain low, particularly in men 3, 4
2. Overreliance on T-scores alone: Consider underlying pathophysiology and clinical context 2
3. Inconsistent follow-up: Patients should be scanned on the same DXA scanner for accurate comparison 2
4. Neglecting treatment after diagnosis: Only 23.2% of men diagnosed with osteoporosis receive bone protective treatments 3

Clinical Impact

Early detection and treatment of osteoporosis significantly reduces fracture risk, which is crucial as osteoporotic fractures are associated with chronic pain, disability, decreased quality of life, and increased mortality 1, 4.