DEXA Scan Screening Age Recommendations
DEXA screening should begin at age 65 for all women and age 70 for all men without risk factors, while those with risk factors should be screened earlier based on their specific risk profile. 1
General Screening Recommendations
- Women aged 65 years and older should undergo routine DEXA screening regardless of risk factors 2, 1
- Men aged 70 years and older should undergo routine DEXA screening 1
- The US Preventive Services Task Force recommends selective screening for postmenopausal women younger than 65 years who have elevated risk of osteoporosis based on clinical risk assessment 2, 1
- The American Academy of Family Physicians recommends against routine DEXA screening in women younger than 65 years and men younger than 70 years with no risk factors 1
Earlier Screening for High-Risk Individuals
DEXA screening should be performed earlier in individuals with the following risk factors:
- Previous fragility fracture (at any age) 1
- Long-term glucocorticoid therapy 1, 3
- Medical conditions associated with bone loss (hyperparathyroidism, hypogonadism, chronic inflammatory diseases) 1, 3
- Medications associated with bone loss 1
- Postmenopausal women under 65 with a 10-year major osteoporotic fracture risk ≥9.3% as calculated by FRAX 2, 4
- Men aged 50-69 years with clinical risk factors for low bone mass 5
- Individuals with spinal cord injuries (as soon as medically stable) 1
- Individuals undergoing androgen deprivation therapy for prostate cancer 1
Risk Assessment Considerations
- The FRAX tool is recommended to calculate 10-year fracture risk, though it has limitations 1, 6
- Research shows that the USPSTF-recommended 9.3% major osteoporotic fracture risk threshold for screening women ages 50-64 has a low sensitivity (37%) for detecting osteoporosis 6
- Low body weight alone is an unreliable predictor for identifying osteoporosis (area under ROC = 70%) 7
- Studies indicate that osteoporosis is relatively infrequent in women with distal forearm fracture below age 65, suggesting DXA scanning may not be justified before this age 7
Follow-up and Monitoring Recommendations
- For individuals with normal bone density or mild osteopenia, repeat DEXA in 2-3 years 1
- For individuals with osteoporosis or on treatment, repeat DEXA in 1-2 years to monitor treatment effectiveness 1
- For individuals with spinal cord injuries, follow-up DEXA at 1-2 year intervals 1
Special Populations
- HIV-infected postmenopausal women and men ≥50 years should undergo DEXA scanning 2
- If the initial DEXA in HIV patients does not warrant medical treatment, the test should be repeated every 2-5 years, depending on proximity to treatment thresholds 2
- For individuals with glucocorticoid-induced osteoporosis, treatment should be considered at higher BMD levels (T-score <-1.5) compared to postmenopausal osteoporosis 3
- Z-scores should be calculated using reference data conforming with the individual's gender identity for transgender individuals 1
Common Pitfalls and Caveats
- Relying solely on the 9.3% FRAX threshold for women under 65 may miss many cases of osteoporosis, as this threshold has shown only 37% sensitivity 6
- Focusing only on weight as a risk factor is insufficient; a comprehensive risk assessment is necessary 7
- In patients over 65 years, a baseline DEXA is useful but not absolutely necessary before initiating bone protective therapy, as most will have T-scores below -1.5 3
- For younger individuals where BMD is likely higher, DEXA is more useful in determining if immediate bone protective treatment is needed 3