From the Guidelines
Dual-energy X-ray absorptiometry (DEXA) screening for osteoporosis should generally begin at age 65 for women and age 70 for men with no risk factors, as recommended by the most recent guidelines 1.
Key Considerations for DEXA Screening
- Earlier screening is recommended for postmenopausal women and men over 50 who have risk factors such as low body weight, previous fracture, high-risk medication use (like long-term corticosteroids), rheumatoid arthritis, smoking, excessive alcohol consumption, or family history of osteoporosis.
- Women who experience early menopause (before age 45) should also consider earlier screening.
- The screening interval typically ranges from 1-5 years depending on initial results and risk factors, with higher risk individuals needing more frequent testing.
Importance of DEXA Screening
- DEXA screening is important because osteoporosis often develops silently until a fracture occurs, and early detection allows for preventive treatment with medications like bisphosphonates, lifestyle modifications, calcium and vitamin D supplementation.
- The test is quick, painless, uses minimal radiation, and provides valuable information about bone mineral density to guide treatment decisions and fracture prevention strategies.
Guidelines and Recommendations
- The European Journal of Nuclear Medicine and Molecular Imaging recommends considering DEXA in all women at the age ≥ 65 years, men age > 70 years, and women and men age ≥ 50 years with risk factors for osteoporosis 1.
- The American College of Physicians recommends that clinicians obtain DXA for men who are at increased risk for osteoporosis and are candidates for drug therapy 1.
Risk Factors and Assessment
- Factors that increase the risk for osteoporosis in men include age (>70 years), low body weight (body mass index <20 to 25 kg/m2), weight loss (>10% [compared with the usual young or adult weight or weight loss in recent years]), physical inactivity, corticosteroid use, androgen deprivation therapy, and previous fragility fracture.
- Risk assessments should be updated periodically for men who choose not to be screened.
From the Research
DXA Screening Guidelines
- Clinical practice guidelines recommend bone mineral density (BMD) screening to identify osteoporosis in women aged 65 years and older 2.
- For postmenopausal women under age 65, risk assessment is recommended to guide BMD screening, with an initial BMD test ordered for all women aged 65, and the frequency of re-screening based on age and BMD T score 2.
- In men, some experts recommend initiation of BMD screening at age 70 2.
- The 2013 Official Positions recommend DXA screening in postmenopausal women younger than 65 years and men 50-69 years only in the presence of clinical risk factors for low bone mass, such as low body weight, prior fracture, high-risk medication use, or a disease or condition associated with bone loss 3.
Risk Factors for Osteoporosis
- Risk factors associated with increased risk of osteoporotic fracture include age, a previous fracture, and the presence of a stooped posture 4.
- Hormone replacement therapy (HRT) has been shown to be protective against osteoporosis 4.
- Patients over the age of 60 years with a history of a fracture or evidence of spinal collapse are likely to have osteoporosis and should be offered screening 4.