From the Guidelines
Bone density scans are recommended for all women aged 65 and older, as well as younger postmenopausal women with risk factors for osteoporosis, as stated in the most recent guidelines from 2025 1. The indications for bone density scans in females can be broken down into several key points:
- Women aged 65 and older should undergo bone density testing as a routine screening measure to assess their risk of osteoporosis and fractures.
- Younger postmenopausal women with risk factors for osteoporosis, such as low body weight, history of fracture, family history of osteoporosis, smoking, and excessive alcohol consumption, should also be screened.
- Women who have experienced early menopause or have had prolonged amenorrhea should be considered for bone density testing.
- Medical conditions associated with bone loss, such as hyperparathyroidism, celiac disease, inflammatory bowel disease, or chronic kidney disease, are also indications for bone density testing. Some of the key risk factors for osteoporosis include:
- Low body weight (less than 127 pounds)
- History of fracture as an adult
- Family history of osteoporosis
- Smoking
- Excessive alcohol consumption
- Rheumatoid arthritis
- Use of medications that can cause bone loss, such as glucocorticoids, certain anticonvulsants, and aromatase inhibitors The most recent guidelines from 2025 1 emphasize the importance of screening for osteoporosis to prevent fractures, and recommend using a 2-step approach for postmenopausal women younger than 65 years. It is also important to note that the US Preventive Services Task Force (USPSTF) recommends screening for osteoporosis with dual-energy X-ray absorptiometry (DXA) to prevent fractures, and suggests using a formal clinical risk assessment tool to identify women at elevated risk of osteoporosis 1. In terms of repeat testing, the guidelines recommend that women with normal initial results undergo repeat testing every 2-5 years, with more frequent monitoring for those at higher risk or on osteoporosis treatments 1.
From the Research
Indications for Bone Density Scans in Females
The following are indications for bone density scans in females, particularly in the context of rheumatoid arthritis (RA):
- Rheumatoid arthritis diagnosis: Females with RA are at increased risk for osteoporotic fracture due to disease-specific risk factors such as chronic exposure to systemic inflammation, joint damage, and autoantibody positivity 2, 3, 4.
- Risk factors for osteoporosis: Females with RA and additional risk factors such as smoking, calcium and vitamin D deficiency, hypogonadism, and chronic exposure to glucocorticoids may benefit from bone density scans 3, 4.
- Disease activity and duration: Females with high disease activity, longer disease duration, and erosive disease may be at increased risk for bone loss and fractures, making bone density scans a useful diagnostic tool 4, 5.
- Fracture risk assessment: Bone density scans can be used in conjunction with tools such as the FRAX algorithm to assess fracture risk in females with RA 6, 5.
- Monitoring of bone mineral density (BMD): Regular BMD measurement can help identify females with RA who are at risk for osteoporosis and fractures, allowing for early intervention and treatment 2, 5.