At what age should Dual-Energy X-ray Absorptiometry (DEXA) scans be initiated in females?

DEXA Scan Screening Age for Females

All women should begin routine DEXA screening at age 65 years, regardless of risk factors. 1, 2, 3

Standard Screening Age

• Women aged 65 years and older require routine DEXA screening without any additional risk assessment. 1, 2, 3
• The US Preventive Services Task Force, American College of Obstetricians and Gynecologists, and American Academy of Family Physicians all consistently recommend universal screening beginning at age 65. 1, 2, 3
• Women younger than 65 years should not receive routine screening unless they meet specific high-risk criteria. 2, 3

Earlier Screening for High-Risk Women Under Age 65

Postmenopausal women younger than 65 years should undergo DEXA screening only if they have elevated fracture risk based on clinical assessment. 1, 2

Specific High-Risk Criteria Requiring Earlier Screening:

• History of fragility fracture (fracture from minimal trauma) 1, 2, 3
• Body weight less than 127 pounds (58 kg) 1
• Parental history of hip fracture 1
• Long-term glucocorticoid therapy (≥5 mg prednisone daily for ≥3 months) 1, 2, 3
• Medical conditions causing bone loss: hyperparathyroidism, hypogonadism, premature menopause, chronic inflammatory diseases, malabsorption disorders 1, 2, 3
• Medications associated with bone loss (beyond glucocorticoids) 1, 2, 3
• Chronic alcoholism 3
• Early hysterectomy (particularly if it resulted in premature estrogen deficiency) 4

Risk Assessment Tools for Women Under 65:

• The FRAX calculator can help identify postmenopausal women under 65 who warrant screening. 1, 2, 3
• A 10-year major osteoporotic fracture risk of ≥9.3% (equivalent to a 65-year-old white woman with normal BMI and no risk factors) suggests screening is appropriate. 1, 2
• Alternative tools include OST (Osteoporosis Self-Assessment Tool) and ORAI (Osteoporosis Risk Assessment Instrument) for identifying women who need DEXA. 1

Critical Pitfalls to Avoid

• Do not delay screening in high-risk women until age 65 when clear risk factors are present, as significant bone loss and fractures can occur earlier. 2, 3
• Do not screen women under 65 without documented risk factors, as this exposes them to unnecessary testing and potential overtreatment. 2, 3
• Do not assume obesity protects against osteoporosis when other major risk factors (such as alcoholism or glucocorticoid use) are present. 3
• Do not repeat DEXA scans more frequently than every 2 years in low-risk individuals, as the precision of testing requires this minimum interval to detect meaningful change. 2, 5

Screening Intervals After Initial DEXA

• For women with normal bone density (T-score ≥ -1.0), repeat screening in 2-3 years or longer depending on baseline values. 2
• For women with osteopenia (T-score between -1.0 and -2.5), repeat in 2-3 years unless baseline T-score is less than -2.0. 2
• For women with osteoporosis or on treatment, repeat in 1-2 years to monitor treatment response. 2, 3
• Women with normal BMD at age 65 may not require repeat testing for up to 17 years, as transition to osteoporosis occurs very slowly in this population. 1, 2