From the Guidelines
Osteoporosis is primarily screened using dual-energy X-ray absorptiometry (DXA) scans, which measure bone mineral density at the hip and spine, and is recommended for all women aged 65 and older and men aged 70 and older, as well as younger individuals with risk factors, as stated in the 2022 update by the American College of Radiology 1.
Screening Recommendations
The screening recommendations are based on the patient's age and risk factors, with the following guidelines:
- Women aged 65 and older should be screened for osteoporosis using DXA scans 1
- Men aged 70 and older should be screened for osteoporosis using DXA scans 1
- Younger individuals with risk factors such as previous fractures, long-term steroid use, rheumatoid arthritis, smoking, excessive alcohol consumption, low body weight, or family history of osteoporosis should be screened using DXA scans 1
Screening Tools
In addition to DXA scans, other screening tools include:
- FRAX calculator, which estimates 10-year fracture risk based on clinical factors
- Quantitative ultrasound, which is sometimes used as a preliminary screening method
- Blood tests to rule out secondary causes of bone loss, including calcium, vitamin D levels, thyroid function, and kidney function tests
Importance of Screening
Early detection through appropriate screening allows for timely intervention with medications, calcium and vitamin D supplementation, and lifestyle modifications to prevent fractures, which can significantly reduce osteoporosis-associated morbidity and mortality, and reduce the considerable cost to the health care system 1.
From the Research
Osteoporosis Screening Methods
- Dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis, measuring bone mineral density (BMD) at sites such as the lumbar spine, femoral neck, and total hip 2, 3
- DXA results can be interpreted using the World Health Organization (WHO) T-score definition of osteoporosis, and have a proven ability to predict fracture risk 3
- Questionnaire-based techniques, such as the FRAX tool, can identify individuals at risk of having low BMD and osteoporosis, and can be useful in resource-constrained areas or low-middle income countries 4
Recommendations for Osteoporosis Screening
- The US Preventive Services Task Force (USPSTF) recommends screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older, and in postmenopausal women younger than 65 years who are at increased risk for an osteoporotic fracture 5
- The USPSTF concludes that the evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men 5
- Osteoporosis screening should be individualized, taking into account a patient's risk factors, medical history, and other factors, and should involve shared decision-making between the patient and healthcare provider 6
Risk Factors for Osteoporosis
- Advanced age, genetics, smoking, thinness, and certain diseases and medications can increase the risk of osteoporosis 6, 4
- Postmenopausal women are at higher risk for osteoporosis due to estrogen deficiency, and should be evaluated for risk factors and considered for screening and prevention strategies 6