From the Guidelines
For a 72-year-old patient with a normal Dual-Energy X-ray Absorptiometry (DEXA) scan in 2022, no further imaging is usually necessary.
Guidelines for Osteoporosis Screening
According to the American College of Radiology Appropriateness Criteria, DXA lumbar spine and hip(s) is usually appropriate for osteoporosis screening or initial imaging of clinically suspected low BMD 1.
- The guidelines recommend DXA lumbar spine and hip(s) for the initial imaging of patients with risk factors that could alter BMD, including premenopausal females or males less than 50 years of age 1.
- However, for a 72-year-old patient with a normal DEXA scan, no further imaging is usually necessary, as the patient's bone mineral density is already within the normal range.
Risk Factors for Osteoporosis
The American College of Physicians recommends assessing older men for osteoporosis risk factors and using DXA to screen men at increased risk who are candidates for drug therapy for osteoporosis 1.
- Risk factors for osteoporosis include age, sex, family history, and history of fractures 1.
- However, for a patient with a normal DEXA scan, these risk factors do not necessitate further imaging.
Screening Recommendations
The U.S. Preventive Services Task Force recommends screening for osteoporosis in women 65 years and older and in younger women at increased risk 1.
- The American College of Radiology Appropriateness Criteria also recommends DXA lumbar spine and hip(s) for the follow-up imaging of patients demonstrated to have risk for fracture or surveillance of established low BMD 1.
- However, for a 72-year-old patient with a normal DEXA scan, no further screening is usually necessary.
From the Research
Guidelines for a 72-year-old patient with a normal DEXA scan
- A 72-year-old patient with a normal Dual-Energy X-ray Absorptiometry (DEXA) scan result can be considered to have a low risk of osteoporosis, as the DEXA scan is the globally accepted "gold-standard" method for the noninvasive diagnosis of osteoporosis 2.
- The guidelines for DEXA scan interpretation are based on the T-score concept, which compares an individual's bone mineral density (BMD) to the mean value of a young healthy reference population, with the difference expressed as a standard deviation (SD) 2.
- For a patient with a normal DEXA scan, the T-score is typically above -1 SD, indicating a low risk of osteoporosis 2.
- The Z-score, which describes the number of SDs by which the BMD in an individual differs from the mean value expected for age and sex, can also be used to assess fracture risk 2.
- The International Society for Clinical Densitometry provides guidance on best practices for DEXA measurement and reporting, including quality standards for BMD testing and interpretation 3.
- The indications for bone density testing include adults 65 years of age and older, postmenopausal women under age 65 with risk factors, and adults with fragility fracture or taking medications associated with low bone mass or bone loss 4.
Reporting and Interpretation
- The DEXA report should include patient identification and demographics, identification of the referring provider, indications for the test, an explanation of the technique, and abnormalities in performing the study 4.
- The report should also include BMD values, the T-score and/or Z-score as appropriate, World Health Organization (WHO) classification for diagnosis, risk factors, and recommendations for follow-up 4.
- A normal DEXA scan result does not necessarily mean that the patient is not at risk for osteoporosis, as other factors such as family history, lifestyle, and medical conditions can also contribute to bone health 5, 6.