What are the recommended ages for Dual-Energy X-ray Absorptiometry (DEXA) scans?

DEXA Scan Age Guidelines

All women aged 65 years and older should undergo routine DEXA screening regardless of risk factors, and all men aged 70 years and older should undergo routine DEXA screening. 1, 2

Standard Age-Based Screening

Women

• Age 65 and older: Universal DEXA screening is recommended for all women at this age, with no requirement for additional risk factors 3, 1, 2
• Under age 65 (postmenopausal): Selective screening only if elevated fracture risk is present based on clinical risk assessment 1, 2
• Under age 65 with no risk factors: Routine screening is not recommended 2

Men

• Age 70 and older: Universal DEXA screening is recommended for all men at this age 1, 2
• Under age 70 with no risk factors: Routine screening is not recommended 2

High-Risk Populations Requiring Earlier Screening (Any Age)

The following individuals should undergo DEXA screening regardless of age:

• Previous fragility fracture: Any adult with a history of low-trauma fracture 1, 2
• Long-term glucocorticoid therapy: Individuals on chronic corticosteroid treatment 1, 2
• Medical conditions causing bone loss: Including hyperparathyroidism, hypogonadism, or chronic inflammatory diseases 1, 2
• Medications associated with bone loss: Various drugs that affect bone metabolism 1, 2
• Spinal cord injuries: Screen as soon as medically stable after injury 1, 2
• Androgen deprivation therapy: Men undergoing treatment for prostate cancer 1, 2
• Postmenopausal women under 65 with FRAX score: Those with 10-year major osteoporotic fracture risk ≥9.3% 2

Additional High-Risk Criteria for Women Under 65

For postmenopausal women younger than 65 years, DEXA is indicated if they have:

• History of fragility fracture 3
• Body weight less than 127 lb (58 kg) 3
• Parental history of hip fracture 3

Screening Intervals After Initial DEXA

Normal or Mild Osteopenia

• Repeat in 2-3 years for individuals with normal bone density or mild osteopenia 1, 2
• For women with normal baseline BMD (T-score ≥-1) and no major risk factors, repeat testing may not be necessary for up to 16 years, as progression to treatment threshold is unlikely 1

Osteoporosis or On Treatment

• Repeat in 1-2 years to monitor treatment effectiveness 1, 2

High-Risk for Accelerated Bone Loss

• Shorter intervals (1-2 years) are appropriate for patients on glucocorticoid therapy or with conditions causing rapid bone loss 1

Common Pitfalls to Avoid

• Repeating scans too frequently: Intervals less than 2 years in low-risk patients with normal BMD expose patients to unnecessary radiation and costs without clinical benefit 1
• Screening young, low-risk individuals: Women under 65 and men under 70 without risk factors should not undergo routine screening 2
• Ignoring men: Men account for 24% of hip fractures but only receive 10% of BMD tests; screening and treatment rates in men after fracture are only half those of women 4
• Missing post-fracture screening: Only 19% of people over 65 undergo BMD testing following a fracture, representing a major missed opportunity 4