When to Stop DEXA Scans
There is no established upper age limit for discontinuing DEXA scans—the decision should be based on whether the results will influence treatment decisions and the patient's overall health status, life expectancy, and fracture risk rather than age alone. 1
Key Principles for Discontinuation
The most recent guidelines emphasize that follow-up BMD testing should be undertaken with clearly defined objectives and when the results are likely to influence patient management 1. This represents a fundamental shift from routine serial testing to purpose-driven scanning.
When DEXA Scans May Be Discontinued
Patients with consistently normal bone density (T-score ≥ -1.0) and no risk factors may not require repeat scanning for extended periods:
- Women with normal baseline BMD and bone loss rates ≤1% per year are unlikely to progress to osteoporosis requiring treatment for approximately 16 years after baseline testing 2
- Cohort studies demonstrate that repeating BMD testing at 4-8 year intervals does not improve fracture prediction accuracy in patients with initially normal bone density 3, 4
- The transition to osteoporosis occurs over approximately 17 years for those with normal BMD, compared to only 5 years for those with T-scores in the -1.50 to -1.99 range 3, 4
Patients with limited life expectancy or those for whom treatment would not be pursued should discontinue screening:
- If a patient has advanced comorbidities where fracture prevention treatment would not be initiated regardless of BMD results, further scanning provides no clinical benefit 1
- The test should only be performed when results will meaningfully impact clinical decision-making 1
When DEXA Scans Should Continue
Certain clinical scenarios mandate ongoing surveillance regardless of age:
- Patients on osteoporosis treatment: Follow-up BMD testing aids in monitoring treatment response and should continue at 1-2 year intervals 1, 3
- Patients planning bisphosphonate drug holidays: Repeat BMD testing is essential to monitor individuals prior to temporary cessation and during planned interruption of bisphosphonate therapy 1
- Development of new risk factors: If a fracture occurs or new risk factors develop, testing should resume (though this should not delay treatment for secondary fracture prevention) 1
- High-risk conditions: Patients with conditions causing accelerated bone loss (chronic renal failure, inflammatory arthritis, eating disorders, long-term glucocorticoid therapy >3 months, hypogonadism, androgen deprivation therapy) require continued monitoring at 1-2 year intervals 3
Common Pitfalls to Avoid
Do not discontinue DEXA scans based solely on advanced age. Elderly patients remain at highest fracture risk, and even among those over 75 years with distal forearm fractures, less than 50% have osteoporosis—meaning BMD testing still provides diagnostic value 5. The ACR guidelines specifically note that screening recommendations extend through age 90 for FRAX calculations 1.
Avoid routine serial testing in low-risk patients with normal BMD. The current OHIP policy allowing BMD tests every 24 months for low-risk individuals exceeds what evidence supports—patients with normal baseline BMD (T-score ≥ -1) and no major risk factors do not require repeat testing for many years 2.
Do not perform scans at intervals less than 1 year under any circumstances. These intervals typically don't show clinically meaningful changes and expose patients to unnecessary radiation and costs without clinical benefit 3, 4.
Recognize that BMD testing after age 65-70 in previously unscreened individuals is still appropriate. Guidelines recommend routine screening for women ≥65 years and men ≥70 years, with no upper age cutoff specified 1, 4. The decision to screen should be based on whether the patient is a candidate for treatment, not chronological age alone.