Should an 84-year-old female who hasn't had a Dual-Energy X-ray Absorptiometry (DEXA) scan undergo this test?

DEXA Scan Recommendation for 84-Year-Old Female

Yes, an 84-year-old female who has never had a DEXA scan should absolutely undergo this test now. 1, 2

Primary Rationale

All women aged 65 years and older should undergo routine DEXA screening regardless of risk factors. 3, 1 At 84 years old, this patient is nearly two decades past the age threshold for universal screening, making this a clear-cut recommendation. 1, 2

Why This Matters at Age 84

• Osteoporosis prevalence increases dramatically with age, affecting up to 30% of women at some point in their lives, with the highest rates in older women. 4
• Hip fractures in this age group significantly affect morbidity, mortality, and quality of life, making fracture prevention critically important. 5
• There is no upper age limit for screening as long as the patient has reasonable life expectancy and functional status. 2
• The baseline scan will establish her current bone density status and guide treatment decisions if osteoporosis is detected. 2

What to Order

Order DEXA of both lumbar spine and bilateral hips (total hip and femoral neck). 3, 1, 2 However, understand that hip measurements will be more reliable than spine measurements at this age due to the high likelihood of degenerative changes that can falsely elevate lumbar spine BMD values. 3, 2

Also request Vertebral Fracture Assessment (VFA) if her T-score is ≤-1.0, given that she is over 70 years old. 3, 1, 2 VFA can be performed concurrently with DEXA at the same visit. 3

Critical Assessment Before Scanning

Before ordering the scan, evaluate for these key factors that may already indicate osteoporosis or affect management:

• Height loss >4 cm suggests possible vertebral compression fractures and confirms the need for VFA. 1, 2
• History of any fragility fracture (fracture from standing height or less) confirms osteoporosis diagnosis regardless of DEXA results. 2, 5
• Medications affecting bone: glucocorticoids, aromatase inhibitors, anticonvulsants, chronic heparin, or androgen deprivation therapy. 3, 1
• Medical conditions: chronic kidney disease, rheumatoid arthritis, malabsorption disorders, hyperparathyroidism, hyperthyroidism, or chronic alcoholism. 3, 2
• Lifestyle factors: smoking, excessive alcohol use, inadequate calcium/vitamin D intake, or sedentary lifestyle. 2, 5

Follow-Up Intervals After Initial Scan

The timing of repeat scans depends entirely on the initial results:

• If osteoporosis is present (T-score ≤-2.5) or she starts treatment: Repeat DEXA every 1-2 years to monitor treatment effectiveness. 1, 2
• If normal bone density or mild osteopenia: Repeat DEXA every 2-3 years. 1
• If moderate osteopenia (T-score -1.5 to -1.99): Consider repeat in approximately 5 years unless new risk factors develop. 1

Common Pitfalls to Avoid

• Do not delay screening further simply because she has reached advanced age—screening remains valuable for fracture prevention. 2
• Be aware that spinal degenerative changes (spondylosis, facet arthritis) can falsely elevate lumbar spine BMD in over 81% of cases with spuriously elevated measurements. 3, 2 Rely primarily on hip measurements for diagnosis in this scenario. 2
• Do not assume she doesn't need treatment if found to have osteoporosis—although data on treatment efficacy in women over 85 is limited, fracture prevention remains the priority if she has reasonable life expectancy. 2
• Ensure adequate calcium and vitamin D intake and counsel on weight-bearing exercise, smoking cessation, and fall prevention regardless of scan results. 5, 6