At what age should Dual-Energy X-ray Absorptiometry (DEXA) screenings start?

DEXA Screening Recommendations by Age

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

Standard Screening Recommendations

• Women age 65 and older: Universal DEXA screening recommended
• Men age 70 and older: Universal DEXA screening recommended
• Women under 65: Screening only with risk factors
• Men ages 50-69: Screening only with risk factors

Risk Factors That Warrant Earlier Screening

Earlier screening is appropriate for individuals with the following risk factors:

• Low body weight (BMI <20-25 kg/m²)
• Prior fracture
• High-risk medication use (especially corticosteroids)
• Diseases or conditions associated with bone loss
• Weight loss >10% compared to usual adult weight
• Physical inactivity
• Current smoking
• Loss of height or thoracic kyphosis
• Chronic inflammatory conditions
• Hypogonadism
• Parental history of hip fracture 2, 3

Age-Specific Screening Algorithm

1. Age ≥65 years (women) or ≥70 years (men):

   • Proceed with DEXA screening regardless of risk factors 1, 2

2. Women ages 50-64 or men ages 50-69:

   • Screen only if one or more risk factors are present
   • Consider using fracture risk assessment tools (e.g., FRAX) to identify candidates for screening 1, 2

3. Under age 50:

   • Routine screening not recommended
   • Consider screening only with significant secondary causes of osteoporosis (e.g., long-term corticosteroid use, hyperparathyroidism)

Follow-up Screening Intervals

• If initial DEXA is normal: Repeat screening in 2 years
• Patients on treatment or at risk for rapid bone loss: Consider shorter intervals (1 year)
• Standard monitoring interval for most patients: 2 years 2

Common Pitfalls to Avoid

1. Overscreening young, low-risk individuals: Evidence shows DEXA screening is commonly overused in women aged 50-59 years (45.5% 7-year cumulative incidence) despite lack of recommendations for this group 4

2. Underscreening high-risk populations: Studies show underutilization of DEXA in women ≥75 years (only 42.7% 7-year cumulative incidence) despite clear recommendations 4

3. Inconsistent follow-up: Ensure appropriate follow-up intervals and use the same DEXA machine for serial measurements to allow meaningful comparison 2

4. Misinterpreting results: For premenopausal women and men <50 years, Z-scores (comparison to age-matched peers) should be used instead of T-scores, with Z-score ≤-2.0 defined as "bone mineral density below the expected range for age" 2

The 2025 US Preventive Services Task Force recommendations maintain these age thresholds, emphasizing that screening should include DEXA with or without fracture risk assessment, and suggesting a 2-step approach for postmenopausal women younger than 65 years 1.