From the Guidelines
Bone density screening is recommended every 1-5 years, depending on the patient's clinical state, with a suggested interval of 1-2 years for individuals with risk factors or those already diagnosed with osteoporosis, as indicated by the most recent evidence 1.
Key Recommendations
- The frequency of bone density screening, or dual-energy X-ray absorptiometry (DXA), should be determined based on the patient's clinical circumstances, including their risk factors and current treatment regimen.
- For women aged 65 and older and men aged 70 and older, screening is generally recommended every 2 years, but this interval may be adjusted based on individual risk factors and clinical conditions.
- Individuals with risk factors, such as a family history of osteoporosis, previous fractures, low body weight, smoking, excessive alcohol consumption, certain medications, and specific medical conditions, may require more frequent screening, typically every 1-2 years.
- The screening interval may be extended to 3-5 years for individuals with normal bone density and no significant risk factors.
Clinical Considerations
- The decision to perform bone density screening should take into account the patient's overall health, medical history, and current treatment regimen.
- The screening interval should be adjusted based on the patient's response to treatment, with more frequent screening recommended for those with a high risk of accelerated bone loss.
- The use of DXA facilities with established precision error and least significant change (LSC) is recommended to ensure accurate and reliable results.
- Follow-up scans should ideally be conducted in the same facility with the same DXA system, if possible, to ensure consistency and accuracy of results.
Evidence-Based Guidelines
- The European Journal of Nuclear Medicine and Molecular Imaging recommends DXA BMD measurement for all women at the age ≥ 65 years, men age > 70 years, and women and men age ≥ 50 years with risk factors for osteoporosis 1.
- The Journal of the American College of Radiology suggests a monitoring time interval of 1 to 2 years for premenopausal women and men 20 to <50 years of age with high risk for accelerated bone loss, but otherwise every 2 years if there are risk factors 1.
- The Annals of Internal Medicine recommends bone density testing for all women aged 65 years or older and all men aged 70 years or older, as well as for postmenopausal women younger than 65 years and men aged 50 to 69 years with risk factors for osteoporosis 1.
From the Research
Bone Density Screening Recommendations
- The United States Preventive Services Task Force recommends bone mineral density (BMD) testing for all women aged 65 or older 2.
- For postmenopausal women under age 65, BMD testing is recommended based on risk assessment, which includes factors such as family history of osteoporosis, personal history of fracture, and medical conditions that may increase the risk of fracture 2, 3.
- The frequency of re-screening should be based on age and BMD T score, with more frequent testing for older age and lower T score 3.
- There is limited evidence to guide osteoporosis screening in men, but some experts recommend initiation of BMD screening in men at age 70 3.
Screening Intervals
- The optimal screening interval for BMD testing has not been established, but it is generally recommended to repeat testing every 2-5 years, depending on the individual's risk factors and BMD results 3.
- More frequent testing may be necessary for individuals with a high risk of fracture or those who are being treated with medications that may affect bone density 3.
Special Considerations
- BMD testing is not recommended for healthy premenopausal women, unless they have a specific risk factor for osteoporosis, such as a family history of osteoporosis or a personal history of fracture 2.
- Women who have neurologic conditions that increase the risk of falling, or those who are taking medications that may affect bone density, such as corticosteroids, should also be considered for BMD testing 2.