Should a person in their late 80s or older be screened for osteoporosis?

Osteoporosis Screening in Adults Late 80s and Older

Yes, individuals in their late 80s or older should continue to be screened for osteoporosis as long as they remain candidates for treatment and have sufficient life expectancy to benefit from fracture prevention. 1, 2

Primary Recommendation

Major guidelines do not establish a specific upper age limit for discontinuing osteoporosis screening. 1, 2 The decision to continue screening should be based on individual factors rather than age alone, as fracture risk continues to increase with advancing age. 1

Key Considerations for Screening in This Age Group

Why Screening Remains Important

• Fracture risk is highest in the oldest adults, making prevention potentially more valuable in those who remain treatment candidates 1, 2
• Hip fractures carry significant one-year mortality risk, with more than one-third of men who experience hip fractures dying within one year 2
• The 2002 USPSTF acknowledged there are no data to determine the appropriate age to stop screening 2
• Research demonstrates that referral for osteoporosis screening inappropriately decreases after age 70, despite this group having the highest risk of osteoporosis and fragility fractures 3

When to Continue Screening

Continue screening if the patient meets ALL of the following criteria:

• Life expectancy exceeds 5-10 years where fracture prevention would meaningfully impact quality of life 1, 2
• Patient is a candidate for osteoporosis treatment (no contraindications to bisphosphonates, denosumab, or other therapies) 1, 2
• Patient does not have severe functional limitations where the burden of screening and treatment outweighs potential benefits 1, 2
• Patient is willing to accept treatment if osteoporosis is diagnosed 1, 2

When to Stop Screening

Discontinue screening if ANY of the following apply:

• Limited life expectancy (generally <5-10 years) where fracture prevention would not meaningfully impact quality of life 1, 2
• Patient would not be a candidate for osteoporosis treatment due to contraindications, severe comorbidities, or patient preference 1, 2
• Severe functional limitations where screening/treatment burden outweighs potential benefits 1, 2

Screening Method and Intervals

• Use DXA of the hip and lumbar spine as the gold standard screening method 1, 4
• Minimum 2-year intervals between screening tests to reliably measure BMD changes 1, 4
• For patients with normal BMD, screening every 2-3 years is appropriate 2
• Patients with osteopenia may need screening every 4-8 years unless baseline T-score is below -2.0 1, 2

Critical Pitfalls to Avoid

• Do not arbitrarily stop screening at a specific age (such as 85 or 90) without considering individual treatment candidacy and life expectancy 1, 2
• Do not assume "too old to treat" - this represents age discrimination, as the oldest adults have the highest fracture risk and mortality from hip fractures 3
• Avoid screening more frequently than every 2 years in patients with normal BMD, as this provides no clinical benefit and causes unnecessary radiation exposure 1
• Do not overlook that treatment benefits emerge 18-24 months after initiation, which should factor into life expectancy considerations 5

Nuance in the Evidence

While the USPSTF recommends routine screening for all women ≥65 years without defining an upper age limit 5, 4, they explicitly acknowledge the lack of data on treatment efficacy in women older than 85 years 2. However, this evidence gap should not automatically preclude screening, as fracture risk and associated mortality continue to increase with age 1, 2. The decision becomes highly individualized based on treatment candidacy and life expectancy rather than chronological age alone.