At what age can a postmenopausal woman with normal bone density stop undergoing regular Dual-Energy X-ray Absorptiometry (DEXA) scans?

When to Stop DEXA Scanning in Postmenopausal Women with Normal Bone Density

There is no established upper age limit for discontinuing DEXA scans; however, women with consistently normal bone density (T-score > -1.0) can reasonably extend screening intervals to 8-15 years or potentially discontinue screening altogether if they remain at low fracture risk. 1

Evidence-Based Screening Intervals for Normal Bone Density

The decision to stop DEXA scanning depends primarily on baseline bone density and ongoing risk assessment rather than age alone:

For Women with Normal BMD at Age 65

• Women with normal baseline bone density take approximately 17 years to transition to osteoporosis, making frequent repeat screening unnecessary 1
• Repeat DEXA scanning in 2-3 years is recommended for normal bone density or mild osteopenia 1, 2
• Neither repeated BMD measurement nor the change in BMD after 8 years was more predictive of subsequent fracture risk than the original measurement in a prospective study of 4,124 women aged 65 or older 1
• Cohort studies demonstrate that repeating BMD testing at intervals of 4-8 years does not result in additional accuracy in predicting fractures 1

Minimum Interval Requirements

• A minimum of 2 years is needed to reliably measure a change in BMD due to limitations in testing precision 1
• Scan intervals less than 1 year are not recommended under any circumstances 1
• Repeating DEXA scans too frequently (less than 2 years apart) in patients with normal BMD exposes patients to unnecessary radiation and costs without clinical benefit 1

When Continued Monitoring IS Required

Certain clinical scenarios mandate ongoing surveillance regardless of baseline bone density:

High-Risk Conditions Requiring 1-2 Year Intervals

• Glucocorticoid therapy for >3 months requires monitoring every 1-2 years due to accelerated bone loss 1, 3
• Androgen deprivation therapy, aromatase inhibitor therapy, or chronic anticonvulsant use necessitates continued surveillance 1
• Conditions causing secondary osteoporosis (hyperparathyroidism, hyperthyroidism, Cushing syndrome, chronic renal failure, rheumatoid arthritis, eating disorders, organ transplantation, gastrointestinal malabsorption) require ongoing monitoring 3, 1
• Prolonged immobilization or spinal cord injury warrants follow-up at 1-2 year intervals 1

Baseline T-Score Considerations

• Women with baseline T-scores between -1.50 and -1.99 transition to osteoporosis in approximately 5 years, requiring more frequent monitoring 1
• BMD measurements do not need to be repeated routinely in patients with osteopenia unless the baseline T-score is < -2.0 or new risk factors develop 1

Clinical Approach to Discontinuation

Risk Assessment at Each Encounter

Assess for new risk factors at each clinical visit rather than relying solely on scheduled DEXA scans 1:

• Development of conditions associated with bone loss 1
• New medications affecting bone metabolism 1
• Height loss >4 cm or kyphosis development 1
• New fragility fractures 4

When Discontinuation May Be Reasonable

For a postmenopausal woman with:

• Consistently normal bone density (T-score > -1.0) on multiple scans 1
• No new risk factors for accelerated bone loss 1
• Age >75-80 years with limited life expectancy where fracture prevention would not meaningfully impact quality of life

Discontinuation of routine screening may be appropriate, though this should be balanced against the individual's overall health status and functional capacity.

Common Pitfalls to Avoid

• Do not repeat DEXA scans at intervals <2 years in women with normal BMD, as precision limitations make shorter intervals clinically meaningless 1
• Do not assume that all elderly women require continued screening indefinitely—the evidence shows diminishing returns after initial normal results 1
• Do not fail to recognize new risk factors that would warrant resuming surveillance even after extended intervals 1
• Be aware that different DXA machines may exhibit variation in measurements unless cross-calibration has been performed 1

Practical Algorithm

1. Initial DEXA at age 65 for all women 1, 2
2. If T-score > -1.0 and no risk factors: Repeat in 4-8 years or consider discontinuation after age 75-80 1
3. If T-score -1.0 to -1.49: Repeat in 3-5 years 1
4. If T-score -1.5 to -1.99: Repeat in 2-3 years 1
5. If new high-risk conditions develop: Resume 1-2 year monitoring regardless of previous results 1, 3