Bone Density Screening Age for Women
All women should begin routine bone density (DEXA) screening at age 65 years, regardless of risk factors. 1, 2
Universal Screening Threshold
- Age 65 is the standard starting point for bone density testing in all women, as consistently recommended by the US Preventive Services Task Force, American College of Obstetricians and Gynecologists, and American Academy of Family Physicians 1, 2
- The National Osteoporosis Foundation similarly recommends bone density testing for all women aged 65 years or older 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. 1, 2
Specific High-Risk Criteria Warranting Earlier Testing:
- History of fragility fracture as an adult 1, 2
- Body weight less than 127 pounds 1
- Parental history of hip fracture 1
- Long-term glucocorticoid therapy (≥5 mg prednisone daily for ≥3 months) 1, 2
- Medical conditions causing bone loss (hyperparathyroidism, hypogonadism, malabsorption disorders) 2, 4
- Medications associated with bone loss (chronic thyroxine overtreatment, chronic heparin therapy) 2, 4
Risk Assessment for Women Under 65:
- Use the FRAX calculator to identify postmenopausal women under 65 who warrant screening 1
- A 10-year major osteoporotic fracture risk of ≥9.3% indicates screening is appropriate 1
Common Pitfalls to Avoid
- Do not screen healthy premenopausal women unless they have specific medical conditions or medications causing accelerated bone loss 4
- Do not withhold screening from women aged 65 or older based on absence of risk factors—universal screening applies at this age 1, 2
- Avoid routine screening in women younger than 65 years without documented risk factors, as this is not recommended 2