From the Guidelines
Bone density screening is recommended for women aged 65 and older and men aged 70 and older, as well as for younger adults with risk factors, according to the most recent guidelines from the International Society for Clinical Densitometry (1). The criteria for bone density screening include:
- All women 65 years of age and men 70 years of age (asymptomatic screening) (1)
- Women <65 years of age who have additional risk for osteoporosis, based on medical history and other findings, such as estrogen deficiency, history of maternal hip fracture, low body mass, or history of amenorrhea (1)
- Women <65 years of age or men <70 years of age who have additional risk factors, including current use of cigarettes, loss of height, or thoracic kyphosis (1)
- Individuals with bone mass osteopenia or fragility fractures on imaging studies such as radiographs, CT, or MRI (1)
- Individuals 50 years of age who develop a wrist, hip, spine, or proximal humerus fracture with minimal or no trauma, excluding pathologic fractures (1)
- Individuals of any age who develop one or more insufficiency fractures (1) Screening should be performed using dual-energy X-ray absorptiometry (DXA) of the hip and lumbar spine, which measures bone mineral density and provides T-scores (1). The American College of Physicians also recommends that clinicians periodically perform individualized assessment of risk factors for osteoporosis in older men and obtain dual-energy x-ray absorptiometry for men who are at increased risk for osteoporosis and are candidates for drug therapy (1). However, the most recent and highest quality study (1) provides the most up-to-date guidelines for bone density screening. It is essential to note that osteoporosis is often asymptomatic until a fracture occurs, and early detection allows for interventions that can significantly reduce fracture risk through medications and lifestyle modifications. Rescreening is typically recommended every 2-5 years depending on baseline results and risk factors, with more frequent monitoring needed for those on osteoporosis medications or with significant risk factors.
From the Research
Criteria for Bone Density Screening
The criteria for bone density screening are based on various factors, including age, gender, and risk factors for osteoporosis.
- Women aged 65 years and older are universally recommended to undergo bone mineral density (BMD) screening to identify osteoporosis 2, 3, 4, 5.
- Postmenopausal women under age 65 should undergo BMD screening if they have risk factors for fracture, such as a family history of osteoporosis, personal history of fracture, or medical conditions associated with accelerated bone loss 2, 3, 4, 5.
- Men aged 70 years and older are recommended to undergo BMD screening 2, 4.
- Younger postmenopausal women and men aged 50-69 years should undergo screening if they have at least one major or two minor risk factors for osteoporosis 4.
- Clinical risk assessment tools, such as the WHO fracture-risk algorithm, can be used to evaluate absolute fracture risk and guide decisions regarding osteoporosis treatments 4, 5.
Risk Factors for Osteoporosis
Several risk factors can increase the likelihood of osteoporosis, including:
- Family history of osteoporosis with fracture 3
- Personal history of fracture as an adult 3
- Medical conditions associated with accelerated bone loss, such as intestinal diseases or primary hyperparathyroidism 3
- Surgical conditions, such as bowel resection or obesity surgery 3
- Medication use, such as corticosteroid therapy or chronic heparin therapy 3
- Neurologic conditions that increase the risk of falling 3
Screening Intervals
The frequency of BMD screening should be based on age and BMD T score, with more frequent testing for older age and lower T score 2, 6.