DEXA Screening for an 86-Year-Old Female
Yes, DEXA screening remains appropriate for an 86-year-old woman, particularly if she has not had recent bone density assessment, has developed new risk factors, or requires monitoring of osteoporosis treatment. 1, 2
Primary Screening Recommendation
The standard guideline recommends routine DEXA screening for all women aged 65 years and older, regardless of risk factors. 1, 2 Your 86-year-old patient clearly falls within this age range and qualifies for screening based on age alone.
Clinical Context for This Age Group
At 86 years old, several important considerations apply:
If she has never had a DEXA scan: She should absolutely undergo baseline screening, as the prevalence of osteoporosis increases substantially with age and she is at high risk for fragility fractures. 1
If she had a previous normal DEXA: The decision depends on when it was performed and whether new risk factors have emerged. Evidence suggests that screening intervals can be extended in women with normal baseline bone density, but this patient's advanced age warrants reassessment. 1
If she has known osteoporosis or is on treatment: She should have repeat DEXA every 1-2 years to monitor treatment effectiveness. 1, 3
Key Clinical Factors to Assess
Before ordering the DEXA, evaluate:
History of fragility fractures: Any low-trauma fracture supersedes DEXA results and confirms osteoporosis diagnosis. 4
Height loss >4 cm: This suggests possible vertebral compression fractures and warrants both DEXA and vertebral fracture assessment (VFA). 1
Medications affecting bone: Glucocorticoids (≥5 mg prednisone daily for ≥3 months), aromatase inhibitors, androgen deprivation therapy, or anticonvulsants. 4, 1
Medical conditions: Chronic kidney disease, rheumatoid arthritis, malabsorption disorders, hyperparathyroidism, or hyperthyroidism. 4
Lifestyle factors: Smoking, excessive alcohol use, inadequate calcium/vitamin D intake, or sedentary lifestyle. 4
Vertebral Fracture Assessment Consideration
If her T-score is ≤-1.0, VFA should be performed concurrently with DEXA given that she is over 70 years old. 1 VFA can identify vertebral fractures that may be asymptomatic but significantly increase future fracture risk.
Important Caveats
Spinal degenerative changes: At 86, she likely has significant spinal arthritis that can falsely elevate lumbar spine BMD measurements. The hip measurement becomes the primary diagnostic site in this scenario. 4, 3
No upper age limit: There is no guideline recommending cessation of screening at any specific age, though data on treatment efficacy in women over 85 is limited. 4 However, if she has reasonable life expectancy and functional status, screening remains valuable for fracture prevention.
Treatment implications: The decision to screen should consider whether results would change management. If she is already on appropriate osteoporosis treatment or has contraindications to all therapies, screening may have limited utility.
Practical Approach
Order DEXA of both lumbar spine and hip, with the understanding that hip measurements will be more reliable given her age. 4 Request VFA if T-score is ≤-1.0 or if she has height loss or kyphosis. 1
The scan should assess:
- Lumbar spine (L1-L4)
- Total hip and femoral neck bilaterally
- Consider forearm if hip and spine cannot be measured
Follow-up intervals will depend on results: every 1-2 years if osteoporosis is present or she's on treatment, or every 2-3 years if bone density is normal or shows mild osteopenia. 1