DEXA Scan Frequency in Established Osteoporosis
For patients with established osteoporosis, repeat DEXA scans should be performed every 1-2 years, with the specific interval determined by treatment status and clinical risk factors. 1
Monitoring Intervals Based on Clinical Context
Patients on Active Treatment
- Perform DEXA every 1-2 years to assess treatment response and bone mineral density changes 1
- Patients receiving glucocorticoid therapy require more frequent monitoring at 1-year intervals due to accelerated bone loss 1
- Men on androgen deprivation therapy (LHRH agonists) should have follow-up scans after 1 year of therapy, then every 2 years for standard risk patients 2
Untreated Patients with Risk Factors
- Monitor every 2 years for patients with osteoporosis who have risk factors but are not yet on treatment 1
- This interval allows adequate time to detect clinically meaningful BMD changes given the precision of DEXA measurements 2
Key Considerations for Scan Timing
Avoid Excessive Scanning
- Do not order DEXA more frequently than annually, as the precision of measurements and rate of bone turnover make more frequent scanning clinically unhelpful and wasteful 2
- The measurement precision of DEXA and the biological rate of bone remodeling require sufficient time between scans to detect meaningful changes
Anatomic Sites to Monitor
- Order DXA of lumbar spine and hip(s) as the primary modality (appropriateness rating 9/9) 1, 2
- Include femoral neck measurement in addition to total hip and lumbar spine (L2-L4) for comprehensive assessment 2
- For patients with advanced degenerative spine changes, quantitative CT may be more appropriate than standard DEXA 3, 1
Common Pitfalls to Avoid
- Avoid ordering scans more frequently than annually unless there is a specific clinical indication such as initiation of high-risk medications 2
- Do not use generic "screening for osteoporosis" as the indication for repeat scans—document that this is monitoring of established osteoporosis to ensure insurance authorization 2
- Ensure proper documentation of treatment status and any changes in risk factors to justify the timing of repeat scanning 2