DEXA Scan Recommendations for Men
DEXA scans are recommended for all men aged 70 years and older, while men under 70 should only be screened if they have specific risk factors for osteoporosis. 1
Age-Based Recommendations
- Men ≥70 years: Universal screening recommended
- Men <70 years: Selective screening based on risk factors
Risk Factors That Warrant DEXA Screening in Men Under 70
Strong Risk Factors:
- Low body weight (BMI <20-25 kg/m²)
- Weight loss >10% compared to usual adult weight
- Physical inactivity
- Previous fragility fracture
- Systemic corticosteroid therapy
- Androgen deprivation therapy
- Spinal cord injury 2
Additional Risk Factors:
- Chronic inflammatory conditions
- Hypogonadism
- Height loss or thoracic kyphosis
- Parental history of hip fracture
- Current smoking
- Chronic alcoholism or established cirrhosis 1
Secondary Causes Warranting Screening
- Endocrine disorders (hyperparathyroidism, hyperthyroidism, Cushing syndrome)
- Gastrointestinal disorders (malabsorption, inflammatory bowel disease)
- Rheumatologic conditions (rheumatoid arthritis and other inflammatory arthritides)
- History of gastric bypass surgery
- Eating disorders 1
Diagnostic Criteria
- Normal: T-score > -1.0
- Osteopenia: T-score between -1.0 and -2.4
- Osteoporosis: T-score ≤ -2.5 1
Follow-up Recommendations
- If initial DXA is normal: Repeat in 2 years
- If on treatment or at risk for rapid bone loss: Consider shorter intervals (1 year)
- Scan intervals <1 year are discouraged 1
Treatment Indications
- T-score ≤ -2.5 at any major site
- Previous fragility fracture (regardless of BMD)
- Osteopenia with 10-year hip fracture risk ≥3% or major osteoporotic fracture risk ≥20% based on FRAX 1
Important Considerations
- Bone density measurement with DXA is the accepted reference standard for diagnosing osteoporosis in men 2
- Alternative screening methods like calcaneal ultrasonography and the Osteoporosis Self-Assessment Tool (OST) are not sufficiently sensitive or specific to substitute for DXA 2
- CT Hounsfield units may detect osteoporosis in patients with normal or osteopenic DEXA results, suggesting DEXA may be particularly insensitive for male bone quality 3
Clinical Pitfalls to Avoid
- Underdiagnosis: Osteoporosis in men is substantially underdiagnosed and undertreated despite a 25% lifetime risk of osteoporotic fracture for a 60-year-old white man 2
- Mortality risk: The 1-year mortality rate in men after hip fracture is twice that in women 2
- Relying solely on lumbar spine measurements: Studies show discordance between DEXA and CT measurements, particularly in men 3
- Missing secondary causes: Always evaluate for underlying causes when osteoporosis is diagnosed in men
By following these evidence-based recommendations for DEXA screening in men, clinicians can identify those at risk for osteoporosis and initiate appropriate interventions to reduce fracture risk and associated morbidity and mortality.