DEXA Scan Recommendations for Men

DEXA scans should be performed in men aged 70 years or older, and in younger men with specific risk factors for osteoporosis and fractures. 1

Age-Based Recommendations

Men aged 70 years or older should undergo screening DEXA scans regardless of other risk factors 1
Men aged 50-69 years should have individualized risk assessment before considering DEXA scanning 1
By age 65, at least 6% of men have DXA-determined osteoporosis, making risk assessment before this age reasonable 1

DEXA scans are recommended for men under 70 years with the following risk factors:

Previous fragility fracture 1
Long-term glucocorticoid therapy (≥5 mg prednisone or equivalent daily for ≥3 months) 1
Hypogonadism or androgen deprivation therapy 1
Height loss >4 cm (>1.5 inches) 1
Medical conditions associated with bone loss:
- Chronic renal failure 1
- Rheumatoid arthritis and inflammatory arthritides 1
- Malabsorption disorders (celiac disease, inflammatory bowel disease) 1
- Primary hyperparathyroidism 1
- Hyperthyroidism 1
- Chronic liver disease 1
Medications that adversely affect BMD:
- Anticonvulsants 1
- Chronic heparin therapy 1
Low body weight (BMI <20-25 kg/m²) 1
Significant weight loss (>10% compared to usual adult weight) 1
Physical inactivity 1
Spinal cord injury 1

Men receiving androgen deprivation therapy (ADT) for prostate cancer should have baseline DEXA scanning before or within 6 months of starting therapy 1
Follow-up DEXA scans should be performed at 1-2 year intervals during ADT 1
When using FRAX risk assessment in men with prostate cancer on ADT, "secondary osteoporosis" should be selected when femoral neck BMD is not available 1

All men with spinal cord injuries resulting in permanent motor or sensory dysfunction should have DEXA scanning of total hip, proximal tibia, and distal femur as soon as medically stable 1
Follow-up scans should be performed at 1-2 year intervals 1

Screening should be based on assessment of clinical factors including hormone therapy compliance, gonadal removal, and additional risk factors 1
Z-scores should be calculated using reference data conforming with the individual's gender identity 1

For men at high risk of accelerated bone loss, follow-up DEXA should be performed at 1-2 year intervals 1
For men with stable risk factors, follow-up DEXA should be performed every 2 years 1
For men with normal baseline BMD (T-score ≥-1) and no major risk factors, repeat testing may not be necessary for at least 3 years 2

In men ≥50 years, T-scores are used with the same diagnostic thresholds as in women (osteoporosis: T-score ≤-2.5; osteopenia: T-score between -1 and -2.5) 3
In men <50 years, Z-scores should be used instead of T-scores, with Z-scores ≤-2.0 defined as "below the expected range for age" 1
A diagnosis of osteoporosis cannot be made in men <50 years based on BMD alone 1

DXA may underestimate fracture risk in certain conditions such as glucocorticoid-induced osteoporosis and type 2 diabetes 1
Advanced degenerative changes in the spine can falsely elevate BMD values, requiring careful inspection of images 1
Men account for 24% of hip fractures but only 10% of BMD tests, indicating significant underdiagnosis 1
Only 19% of people over 65 years undergo BMD testing after a fracture, with rates in men only half those in women 1