From the Guidelines
Women should start bone densitometry screening at age 65, or at age 60 if they are at increased risk for osteoporotic fractures. This recommendation is based on the guidelines from the U.S. Preventive Services Task Force (USPSTF) 1. The USPSTF found good evidence that the risk for osteoporosis and fracture increases with age and other factors, and that bone density measurements accurately predict the risk for fractures in the short term.
Key Considerations
- The USPSTF recommends routine screening for women 65 years of age and older, and for women at increased risk for osteoporotic fractures at 60 years of age 1.
- Women at increased risk for osteoporotic fractures include those with a family history of osteoporosis, history of fractures, low body weight, smoking, excessive alcohol consumption, rheumatoid arthritis, early menopause, or use of medications that affect bone health.
- The screening test, called dual-energy X-ray absorptiometry (DXA), measures bone mineral density to assess fracture risk and diagnose osteoporosis before fractures occur.
- Early intervention with lifestyle modifications and medications can help prevent further bone loss and reduce the risk of fractures.
Rationale
The USPSTF found fair evidence that screening women at lower risk for osteoporosis or fracture can identify additional women who may be eligible for treatment for osteoporosis, but it would prevent a small number of fractures 1. Therefore, the balance of benefits and harms of screening and treatment is too close to make a general recommendation for women younger than 60 years of age or for women 60 to 64 years of age who are not at increased risk for osteoporotic fractures.
Clinical Implications
The goal of bone densitometry screening is to identify bone loss early when preventive measures can be most effective, as women typically lose bone mass rapidly in the first 5-7 years after menopause due to declining estrogen levels, which play a crucial role in maintaining bone density. By starting screening at age 65, or at age 60 for women at increased risk, healthcare providers can help prevent osteoporosis and related fractures, and improve the quality of life for their patients.
From the Research
Bone Densitometry Screening in Women
- The recommended age to start bone densitometry (Dual-Energy X-ray Absorptiometry - DEXA) screening in women is 65 years and older, as stated in clinical practice guidelines 2.
- For postmenopausal women under 65, risk assessment is recommended to guide BMD screening, with no standard approach to risk assessment existing 2.
- The 2013 Official Positions of the International Society for Clinical Densitometry endorse the National Osteoporosis Foundation (NOF) guidelines, which recommend DXA screening in postmenopausal women younger than 65 years and men 50-69 years only in the presence of clinical risk factors for low bone mass 3.
- Clinical risk factors for fracture, such as low body weight, prior fracture, high-risk medication use, or a disease or condition associated with bone loss, should be considered when deciding to start BMD screening in women under 65 3.
Screening Intervals
- The estimated BMD testing interval is 16.8 years for women with normal BMD, 17.3 years for women with mild osteopenia, 4.7 years for women with moderate osteopenia, and 1.1 years for women with advanced osteopenia 4.
- Serial BMD measurements every 24 months may not be necessary for people with no major risk factors for osteoporosis, provided that the baseline BMD is normal and the rate of bone loss is less than or equal to 1% per year 5.
Special Considerations
- The World Health Organization (WHO) classification of bone mineral density is based on population studies in postmenopausal women and should not be applied to premenopausal women 6.
- In men under 50 years of age, premenopausal women, and children, Z-scores, not T-scores, should be used when reporting bone density results 6.