Can a Dual-Energy X-ray Absorptiometry (DEXA) scan be performed annually?

From the Guidelines

DEXA scans should not be done yearly for most people, but rather every 2-3 years for those with certain risk factors, as recommended by the most recent and highest quality study 1.

Recommendation Rationale

The decision to perform DEXA scans yearly is generally not recommended due to several factors, including the slow change in bone density over time and the minimal radiation exposure associated with the test. However, certain high-risk individuals may require more frequent scanning.

• The study published in 2024 1 suggests that for people with type 2 diabetes, DEXA scans should be performed at least 5 years after diagnosis and reassessed every 2-3 years, depending on individual risk factors.
• Another study from 2019 1 recommends repeating DEXA scans after 2-3 years in patients with normal bone mineral density (BMD) and within 1 year when rapid bone loss is expected.

Key Considerations

• Bone density changes relatively slowly, making annual changes often within the margin of error of the test itself.
• DEXA scans involve a small amount of radiation exposure, and limiting unnecessary exposure is prudent.
• Certain medical conditions, such as chronic liver disease or type 2 diabetes, may require more frequent DEXA scans due to increased risk of bone loss and fractures.
• Medications that cause bone loss, such as long-term corticosteroids, may also necessitate more frequent scanning.

Individualized Approach

• Healthcare providers should determine the appropriate testing interval based on individual risk factors, age, gender, and medical history.
• More frequent scanning may be necessary for certain high-risk individuals, but this should be determined on a case-by-case basis.

From the Research

DXA Scan Frequency

• The frequency of DXA scans is not explicitly stated in the provided studies as being yearly 2, 3, 4, 5, 6.
• However, the studies suggest that DXA scans are used to monitor bone mineral density and assess fracture risk in patients with osteoporosis or those at risk of developing osteoporosis 2, 4, 5, 6.
• The World Health Organization (WHO) has established DXA as the best densitometric technique for assessing bone mineral density (BMD) in postmenopausal women and based the definitions of osteopenia and osteoporosis on its results 6.
• DXA scans can be used to estimate fracture risk and monitor patients undergoing treatment, but the scan frequency may depend on individual patient needs and risk factors 4, 5, 6.

Guidelines for DXA Scans

• The studies mention various guidelines for assessing fracture risk and treating patients with osteoporosis, including those from the Bone and Tooth Society, National Osteoporosis Society, and Royal College of Physicians 2, 4.
• These guidelines recommend DXA scans for patients at high risk of osteoporosis, such as those over 65 years old or with a history of fragility fractures 4, 5.
• However, the guidelines do not specify a yearly scan frequency, and the decision to perform a DXA scan should be based on individual patient needs and risk factors 4, 5, 6.

Limitations of DXA Scans

• The studies note that DXA scans have limitations, such as underestimating the risk of fracture in patients treated with glucocorticoids 2.
• Additionally, DXA scans may not be necessary for all patients, and other diagnostic tools, such as computed tomography (CT) scans, may be used to assess bone density in certain situations 3.