From the Guidelines
Men should undergo a Dual-Energy X-ray Absorptiometry (DEXA) scan for osteoporosis screening if they are over 70 years old or have risk factors such as a previous fragility fracture, systemic corticosteroid therapy, androgen deprivation therapy, or spinal cord injury, as recommended by the American College of Physicians 1. The indications for a male to undergo a DEXA scan include:
- Age over 70 years
- Previous fragility fracture
- Systemic corticosteroid therapy
- Androgen deprivation therapy
- Spinal cord injury
- Other risk factors such as low body weight, weight loss, physical inactivity, cigarette smoking, and low dietary intake of calcium The DEXA scan is a painless test that measures bone mineral density, typically at the hip and spine, and is the accepted reference standard for diagnosing osteoporosis in men 1. According to the American College of Radiology, DEXA may be used in patients under 65 years of age to evaluate bone mass density if there are additional risk factors, and vertebral fracture assessment and trabecular bone score may further predict fracture risk in patients with osteopenia 1. It is essential to note that bone density testing is crucial because men can develop osteoporosis, typically 10 years later than women, and often do not realize they have bone loss until they experience a fracture 1.
From the Research
Indications for DEXA Scan in Men
The following are indications for a male to undergo a Dual-Energy X-ray Absorptiometry (DEXA) scan for osteoporosis screening:
- Men 70 years and older, as recommended by the Bone Health and Osteoporosis Foundation 2, 3
- Men with clinical risk factors, such as a history of fractures or family history of osteoporosis 2, 3
- Men who have an increased fracture risk as determined by the World Health Organization's FRAX Fracture Risk Assessment Tool or the Male Osteoporosis Risk Estimation Score (MORES) 4, 5
- Men who have a T-score of -2.5 or less, or the presence of a fragility fracture, which can be diagnosed by a DEXA scan 3, 6
Risk Assessment Tools
Several risk assessment tools can be used to identify men who may benefit from a DEXA scan, including:
- The Osteoporosis Self-Assessment Tool (OST) 4
- The Fracture Risk Assessment Tool (FRAX) 4, 2
- The Male Osteoporosis Risk Estimation Score (MORES) 5
Diagnostic Criteria
A DEXA scan can be used to diagnose osteoporosis in men, with a T-score of -2.5 or less indicating osteoporosis 3, 6. The scan can also be used to monitor response to treatment and predict fracture risk 6.