From the Guidelines
The American College of Obstetricians and Gynecologists (ACOG) recommends bone density screening for all women aged 65 and older, regardless of risk factors, based on evidence from the National Osteoporosis Foundation and other professional organizations, as cited in 1. This recommendation is supported by epidemiological evidence showing that osteoporosis prevalence significantly increases after age 65, with approximately one in two women over 65 experiencing an osteoporosis-related fracture in their lifetime. For younger women (under 65), ACOG recommends screening only if they have risk factors equivalent to that of a 65-year-old woman or specific risk factors such as:
- Low body weight (less than 127 pounds)
- History of fracture as an adult
- Family history of osteoporosis
- Early menopause
- Smoking
- Excessive alcohol consumption
- Use of medications that affect bone metabolism (like long-term corticosteroids) ACOG determined these age thresholds through analysis of fracture incidence data, cost-effectiveness studies, and the natural history of bone loss in women, particularly accelerated bone loss that occurs in the 5-7 years following menopause, as discussed in 1. The goal is to identify women at risk before they experience fractures, as bone density screening can detect low bone mass before a fracture occurs, allowing for preventive interventions. Key considerations in determining the age for bone density screening include the balance of benefits and harms of screening and treatment, as well as the accuracy of peripheral bone density testing in comparison with dual-energy x-ray absorptiometry, as noted in 1. Overall, the evidence supports the ACOG recommendation for bone density screening in women aged 65 and older, and in younger women with specific risk factors, as a means of preventing osteoporosis-related fractures and improving quality of life.
From the Research
Age Determination for Bone Density Screening
The American College of Obstetricians and Gynecologists (ACOG) used evidence from various studies to determine the age for bone density screening.
- The ACOG Clinical Practice Guideline No. 1, published in 2021 2, provides updated recommendations for the prevention, screening, and diagnosis of postmenopausal osteoporosis.
- The guideline was developed using a comprehensive literature search and a modified GRADE evidence-to-decision framework to interpret and translate the evidence into recommendation statements.
- However, the specific age for bone density screening is not explicitly stated in the provided evidence.
Related Studies
Other studies have investigated the use of bone density measurements and osteoporosis screening, but they do not provide direct evidence for the age determination.
- A study published in 2020 3 discusses the use of dual-energy X-ray absorptiometry bone densitometry for the management of osteoporosis and highlights the importance of recognizing its pitfalls.
- Another study published in 2020 4 provides practical guidance for the use of bisphosphonates in osteoporosis, but does not address the age for bone density screening.
- A study published in 2025 5 explores the utility of osteoporosis screening using deep-learning-based estimation of bone mineral density from bidirectional chest radiographs.
- A study published in 2008 6 examines the significance of a decline in bone mineral density while receiving oral bisphosphonate treatment, but does not provide information on the age for bone density screening.
Evidence Limitations
The provided evidence does not directly address the age determination for bone density screening. Therefore, it is not possible to determine the specific age used by ACOG based on the available studies.