DXA Scan Screening: Age and Gender Guidelines
DXA screening should begin at age 65 for all women and age 70 for all men, regardless of risk factors, and is definitively NOT exclusive to females. 1, 2
Standard Screening Ages by Gender
Women
- All women aged 65 years and older should undergo routine DXA screening without requiring additional risk factors 1, 3, 2, 4
- Women younger than 65 years should NOT receive routine screening unless specific risk factors are present 3, 2, 4
- Postmenopausal women under age 65 qualify for screening only if they have elevated osteoporosis risk based on clinical assessment 3, 4
Men
- All men aged 70 years and older should undergo routine DXA screening regardless of risk factors 1, 3, 2, 4
- Men younger than 70 years should NOT receive routine screening without documented risk factors 3, 2, 4
- By age 65, at least 6% of men already have DXA-determined osteoporosis, making risk assessment before age 70 reasonable in high-risk individuals 2
High-Risk Individuals Requiring Earlier Screening (Both Genders)
The following conditions justify DXA screening before the standard age thresholds in both women and men:
Medical Conditions
- Previous fragility fracture at any age 3, 2, 4
- Long-term glucocorticoid therapy (≥5 mg prednisone daily for ≥3 months) 3, 2, 4
- Hypogonadism or surgically/chemotherapeutically induced castration 2, 4
- Hyperparathyroidism or other conditions associated with bone loss 3, 4
- Chronic renal failure 2
- Rheumatoid arthritis or chronic inflammatory diseases 2, 4
- Spinal cord injury (screen as soon as medically stable) 3, 2, 4
Specific Risk Factors for Women Under 65
- Body weight less than 127 pounds 2
- Parental history of hip fracture 2
- Early menopause 2
- 10-year major osteoporotic fracture risk ≥9.3% calculated by FRAX 2, 4
Specific Risk Factors for Men Under 70
- Androgen deprivation therapy for prostate cancer 3, 2, 4
- Chronic alcoholism 2, 4
- Low body mass index (<20 kg/m²) 2
High-Risk Medications
Critical Pitfalls to Avoid
- Do not screen women under 65 or men under 70 without documented risk factors – this exposes patients to unnecessary radiation and healthcare costs without clinical benefit 2
- Do not delay screening in patients with chronic alcoholism, glucocorticoid use, or early menopause – these conditions justify earlier screening regardless of age 2, 4
- Do not assume DXA is only for women – approximately one-third of men over 50 will sustain an osteoporotic fracture, and men have significant osteoporosis-related morbidity and mortality 1
- Do not repeat DXA scans more frequently than every 2 years in patients with normal bone density, as testing precision limitations make shorter intervals unreliable 2
- Never repeat DXA at intervals less than 1 year under any circumstances 2