At what age do Dual-Energy X-ray Absorptiometry (DEXA) scans typically start for osteoporosis screening?

DEXA Scan Screening Age Recommendations

Routine DEXA screening should begin at age 65 for all women and age 70 for all men, regardless of risk factors. 1, 2, 3

Standard Screening Ages for Asymptomatic Individuals

• Women aged 65 years and older should undergo routine DEXA screening without requiring any additional risk factors 1, 2, 3
• Men aged 70 years and older should undergo routine DEXA screening without requiring any additional risk factors 1, 2
• Do not perform routine screening in women younger than 65 or men younger than 70 who lack specific risk factors, as this exposes patients to unnecessary radiation and costs without clinical benefit 2, 3

Earlier Screening for High-Risk Individuals (Before Age 65/70)

Women under 65 and men under 70 require DEXA screening only if they have documented risk factors. 1, 3 The following conditions justify earlier screening:

Fracture-Related Risk Factors

• Previous fragility fracture (wrist, hip, spine, or proximal humerus with minimal or no trauma) at any age 1, 2, 3
• Insufficiency fractures at any age 1
• Vertebral fractures identified on imaging studies 1

Medication-Induced Risk Factors

• Long-term glucocorticoid therapy (≥5 mg prednisone daily for ≥3 months) 1, 2, 3
• Androgen deprivation therapy for prostate cancer 1, 2, 3
• Aromatase inhibitor therapy for breast cancer 1, 2
• Chronic heparin therapy 2
• Anticonvulsant drugs 2

Medical Conditions

• Hyperparathyroidism 1, 3
• Hypogonadism or surgically/chemotherapeutically induced castration 2, 3
• Chronic renal failure 2
• Rheumatoid arthritis or chronic inflammatory diseases 2, 3
• Eating disorders 2
• Chronic alcoholism 2, 4
• Organ transplantation 2
• Spinal cord injury (scan as soon as medically stable) 2, 3

Clinical Risk Factors in Postmenopausal Women Under 65

• Body weight less than 127 pounds (57.6 kg) 1, 2
• Maternal hip fracture after age 50 1, 2
• Early menopause or prolonged amenorrhea (>1 year before age 42) 1, 2
• Current cigarette smoking 1
• Loss of height or thoracic kyphosis 1
• 10-year major osteoporotic fracture risk ≥9.3% as calculated by FRAX 2, 3

Screening Intervals After Initial DEXA

The frequency of repeat DEXA depends on baseline bone density and risk factors:

• Normal bone density or mild osteopenia: Repeat DEXA in 2-3 years 2, 3
• Osteoporosis or on treatment: Repeat DEXA in 1-2 years to monitor treatment effectiveness 2, 3
• High-risk conditions (glucocorticoid therapy, spinal cord injury): Repeat DEXA in 1-2 years 2, 3
• Never repeat DEXA at intervals less than 1 year under any circumstances, as testing precision limitations make shorter intervals unreliable 2, 3

Critical Pitfalls to Avoid

• Do not delay screening in patients with chronic alcoholism, early menopause, or glucocorticoid use—these conditions justify earlier screening regardless of age 2, 4
• Do not screen women under 65 or men under 70 without documented risk factors, as this provides no clinical benefit 2, 3
• Do not assume obesity protects against osteoporosis when other major risk factors are present; obesity is not an indication for DEXA but does not eliminate the need for screening in high-risk patients 4
• Do not repeat DEXA more frequently than every 2 years in patients with normal BMD, as measurement precision does not support shorter intervals 2, 3

Scan Technique

Standard DEXA should include both lumbar spine (L1-L4) and bilateral hips (femoral neck and total hip). 1, 2 Use T-scores for all postmenopausal women regardless of age, and Z-scores for premenopausal women and men under 50. 2, 3 Consider Vertebral Fracture Assessment (VFA) during the same session for patients with T-score <-1.0 and additional risk factors such as height loss >4 cm, prior vertebral fracture, or glucocorticoid therapy. 2, 3