When do you stop screening for osteoporosis?

When to Stop Screening for Osteoporosis

Current evidence does not establish a specific upper age limit for stopping osteoporosis screening; the decision should be based on life expectancy, treatment candidacy, and overall health status rather than age alone. 1

Key Screening Recommendations by Age

Women

• All women aged 65 years and older should undergo routine screening with DXA of the hip and lumbar spine, regardless of risk factors 1, 2, 3
• Postmenopausal women younger than 65 years should be screened if their fracture risk equals or exceeds that of a 65-year-old white woman without additional risk factors 1

Men

• Men aged 70 years and older should undergo routine screening 2, 4
• The USPSTF found insufficient evidence to recommend for or against routine screening in men, though some specialty societies recommend screening at age 70 or older 1

Factors Influencing When to Stop Screening

Life Expectancy Considerations

• Screening should continue as long as the patient is a candidate for treatment and has sufficient life expectancy to benefit from fracture prevention 1
• Hip fractures carry 21-30% one-year mortality risk, making prevention valuable even in older adults 1, 5
• More than one-third of men who experience hip fractures die within one year 1

Screening Intervals Guide Stopping Decisions

• For patients with normal bone density (T-score > -1.0), repeat screening every 2-3 years 2
• Women with normal BMD at age 65 may not transition to osteoporosis for almost 17 years, suggesting less frequent screening in this group 2
• Patients with osteopenia (T-score -1.0 to -2.5) may need screening every 4-8 years unless baseline T-score is below -2.0 2
• Those on treatment or at high risk require more frequent monitoring (1-2 years) 2

Clinical Approach to Stopping Screening

Consider Stopping When:

• Patient has limited life expectancy (generally less than 5-10 years) where fracture prevention would not meaningfully impact quality of life 1
• Patient would not be a candidate for osteoporosis treatment due to contraindications, severe comorbidities, or patient preference 1
• Patient has severe functional limitations where the burden of screening and treatment outweighs potential benefits 1

Continue Screening When:

• Patient remains ambulatory and functionally independent 1
• Patient has new risk factors develop (glucocorticoid therapy, height loss >4 cm, new medications affecting bone metabolism) 2
• Patient has osteopenia with T-score below -2.0 at baseline 2

Common Pitfalls to Avoid

• Do not arbitrarily stop screening at a specific age (e.g., 75 or 80 years) without considering individual factors 1
• Avoid repeating DXA scans more frequently than every 2 years in patients with normal BMD, as this provides no clinical benefit and exposes patients to unnecessary radiation 2
• Do not overlook that fracture risk increases with age, making screening potentially more valuable in older adults who remain treatment candidates 1
• Recognize that the yield of screening is actually higher in older women and those with lower baseline BMD 3

Evidence Limitations

The USPSTF explicitly notes that evidence is lacking about optimal intervals for repeated screening and whether screening should continue indefinitely 2. No studies have directly evaluated when to stop screening based on age or other factors 1. This evidence gap means decisions must be individualized based on treatment candidacy, functional status, and life expectancy rather than age cutoffs.