From the Guidelines
A DEXA scan is recommended for women aged 65 and older and men aged 70 and older as part of routine screening for osteoporosis, as well as for women and men aged 50 years and older with risk factors for osteoporosis. This recommendation is based on the most recent and highest quality study, which suggests that DXA measurement should be performed at the lumbar spine, total hip, femoral neck, and, if indicated, one-third radius 1. The study also recommends considering DXA in all women at the age of 65 years, men aged 70 years, and women and men aged 50 years with risk factors for osteoporosis.
Key Indications for DEXA Scan
- Women aged 65 and older
- Men aged 70 and older
- Women and men aged 50 years and older with risk factors for osteoporosis, such as:
- Low body weight
- Previous fracture
- High-risk medication use (e.g., long-term corticosteroids, aromatase inhibitors, or androgen deprivation therapy)
- Medical conditions that affect bone health (e.g., rheumatoid arthritis, type 1 diabetes, liver disease, or celiac disease)
- Individuals who have experienced a fragility fracture or have significant height loss, which might indicate vertebral fractures
Importance of DEXA Scanning
DEXA scanning is valuable because it measures bone mineral density with minimal radiation exposure, providing a T-score that helps assess fracture risk and guides treatment decisions. Early detection through DEXA scanning allows for timely intervention to prevent fractures, which can significantly impact quality of life and mortality risk. The frequency of BMD testing in clinical practice may be influenced by the patient’s clinical state, national clinical guidelines, cost, and reimbursement, with suggested intervals between BMD testing typically ranging from 1-5 years after starting or changing therapy 1.
Follow-Up and Monitoring
Follow-up DXA scans are recommended as indicated, depending on clinical circumstances, and should ideally be conducted in the same facility with the same DXA system, if the acquisition, analysis, and interpretation adhere to recommended standards 1. Procedural certification and repeated audits are also recommended to ensure the quality of DXA scans.
From the Research
When is a DEXA Scan Recommended
- A DEXA scan is recommended for patients who have an increased risk of fracture based on clinical risk factors 2
- The diagnosis of osteoporosis can be confirmed by DEXA if the 10-year risk of major osteoporotic fracture is > 10% 2
- DEXA should be considered if the BMD T-score values at the lumbar spine, femoral neck, or total hip are at or below -2.5 2
- Vertebral fractures are generally taken as diagnostic of osteoporosis, even if spine BMD values are not in the osteoporotic range 2
- In patients with glucocorticoid-induced osteoporosis, therapy should be considered if the BMD T-score is <-1.5 2
- A DEXA scan is useful in determining if bone protective treatment is needed immediately or if it could be delayed until the T score falls below -1.5, especially in younger individuals 2
- Women at 'high risk' of osteoporosis, such as those with a history of early hysterectomy, oral corticosteroids, or a family history of osteoporosis, should be considered for DEXA scanning 3
- Patients over the age of 60 years with a history of a fracture or evidence of spinal collapse are likely to have osteoporosis and should be offered screening 4
- A DEXA scan can be used to monitor the effectiveness of treatment and to assess the risk of fracture in patients with osteoporosis 5, 6