When to Stop DEXA Screening for Osteoporosis
There is no specific age at which to stop DEXA screening; instead, screening should continue as long as the patient remains a candidate for osteoporosis treatment and has sufficient life expectancy (generally 5-10 years or more) to benefit from fracture prevention. 1
Evidence on Age-Based Stopping Points
The most recent 2025 USPSTF guidelines and major professional societies do not establish a specific upper age limit for discontinuing osteoporosis screening. 2 The 2002 USPSTF statement explicitly acknowledged that "there are no data to determine the appropriate age to stop screening and few data on osteoporosis treatment in women older than 85 years of age." 2 This evidence gap persists in current guidelines, though the lack of data does not mean lack of benefit in very elderly patients. 3
Clinical Framework for Deciding When to Stop
Screening should be discontinued when any of the following conditions are met:
Limited life expectancy: The patient has less than 5-10 years of estimated survival, where fracture prevention would not meaningfully impact quality of life or mortality. 1
Not a treatment candidate: The patient has contraindications to all osteoporosis therapies, severe comorbidities precluding treatment, or has declined treatment based on informed preference. 1
Severe functional limitations: The burden of screening, treatment, and monitoring outweighs potential benefits due to advanced frailty or disability. 1
Why Screening Remains Valuable in Advanced Age
Fracture risk increases substantially with age, making screening potentially more valuable—not less—in older adults who remain treatment candidates. 1 Hip fractures carry significant one-year mortality risk, with more than one-third of men and a substantial proportion of women dying within one year of hip fracture. 1 This high morbidity and mortality makes prevention valuable even in patients in their 80s and beyond who are otherwise healthy enough to benefit from treatment. 3
Screening Intervals That Inform Stopping Decisions
Understanding appropriate screening intervals helps determine when continued screening adds value:
Normal bone density at age 65: Women may not transition to osteoporosis for almost 17 years, suggesting that a single normal scan may be sufficient for many women with no additional risk factors. 1, 4
Mild osteopenia (T-score -1.01 to -1.50): Repeat screening every 15-17 years is adequate. 4
Moderate osteopenia (T-score -1.51 to -2.00): Repeat screening every 4-5 years. 1, 4
Advanced osteopenia (T-score -2.01 to -2.49): Repeat screening annually. 4
Common Pitfalls to Avoid
Do not arbitrarily stop screening at age 75,80, or 85 without considering individual treatment candidacy and life expectancy. 1 Age alone should not determine screening cessation.
Avoid repeating DXA scans more frequently than every 2 years in patients with normal BMD or mild osteopenia, as this provides no clinical benefit and exposes patients to unnecessary radiation. 1, 5
Do not withhold screening from very elderly patients (85+ years) based solely on advanced age, as the evidence gap does not mean lack of benefit for those who remain treatment candidates. 3
Recognize that screening underuse is common in appropriate candidates aged 65 and older (only 58% screened by age 65-74 and 43% by age 75+), while overuse occurs in younger, low-risk women. 6
Practical Algorithm for Decision-Making
For women with established osteoporosis: Continue monitoring with DXA every 1-2 years while on treatment, regardless of age, as long as treatment continues. 3
For women aged 65-85 with normal or mildly osteopenic bone density: Consider stopping screening if life expectancy is less than 10 years or patient would decline treatment. 1
For women aged 85+: Continue screening only if the patient is healthy enough to tolerate and benefit from pharmacologic treatment (bisphosphonates, denosumab, or anabolic agents) and has reasonable life expectancy. 3