When to Start DEXA Scanning for Osteoporosis
DEXA scanning should begin at age 65 for all women and age 70 for all men, with earlier screening only for those with significant risk factors for osteoporosis. 1, 2
Recommended Screening Ages by Population
Women:
- Age 65 and older: Universal screening recommended 2, 1
- Under age 65: Screening only with risk factors using a 2-step approach:
- First assess fracture risk with clinical risk assessment tools
- Then perform DEXA if risk assessment indicates elevated risk 2
Men:
- Age 70 and older: Universal screening recommended 1
- Ages 50-69: Screening only with risk factors present 1, 3
Risk Factors That Warrant Earlier Screening
Consider DEXA scanning before the standard ages if any of these risk factors are present:
- Low body weight (<70 kg) 1
- Prior fragility fracture (regardless of age or gender) 1
- Parental history of hip fracture 1
- Current smoking 1
- Excessive alcohol consumption 1
- Long-term glucocorticoid therapy 1, 4
- Chronic inflammatory conditions 1, 4
- Premature menopause or estrogen deficiency 1, 4
- Hypogonadism 1
- Secondary causes of osteoporosis (e.g., malabsorption) 4
- HIV infection (considered a risk factor warranting earlier screening) 2
Special Populations
HIV-Infected Individuals:
- All HIV-infected postmenopausal women and men ≥50 years should undergo DEXA scanning 2
- If initial results don't warrant treatment, repeat every 2-5 years 2
Cancer Patients:
- Earlier screening recommended for patients receiving therapies affecting bone health:
- Aromatase inhibitors for breast cancer
- Androgen deprivation therapy for prostate cancer 1
Common Pitfalls to Avoid
Underscreening high-risk populations: Research shows that only 57.8% of eligible women aged 65-74 and 42.7% of women ≥75 years receive recommended screening 5
Overscreening low-risk populations: About 45.5% of women aged 50-59 and 58.6% of women aged 60-64 without risk factors receive unnecessary screening 5
Failure to recognize risk factors: Many patients with significant risk factors are not identified for earlier screening
Inappropriate screening intervals: Standard monitoring interval is 2 years, with shorter intervals (1 year) for high-risk patients or those starting therapy 1
Using the wrong diagnostic criteria: Remember the WHO definitions:
- Normal: T-score > -1.0
- Osteopenia: T-score between -1.0 and -2.4
- Osteoporosis: T-score ≤ -2.5 1
By following these evidence-based guidelines, you can ensure appropriate screening while avoiding unnecessary testing, ultimately reducing fracture risk and improving quality of life for patients at risk of osteoporosis.