DEXA Scan
When to Order a Screening DEXA Scan
BMD as measured by DEXA scans is used as a surrogate for bone quality and fracture risk. When deciding who to screen, one should consider risk factors and age:
The U.S. Preventive Services Task Force (2002) recommends screening all women over age 65. They also recommend screening women less than 65 who have a FRAX calculated 10-year fracture risk equal to a 65-year-old without additional risk factors (9.3%).
The National Osteoporosis Foundation (NOF 2008) recommends screening all women over age 65 and all men over age 70. They also recommend screening patients between ages 50 and 69 who have increased risk of osteoporosis based on risk factors (low body weight, prior fragility fracture, use of a high risk medication, high-risk condition such as rheumatoid arthritis). They also recommend considering screening in all adults who suffer a fracture after age 50. (13)
As of 2013 the NOF started recommending vertebral xrays or vertebral fracture analysis in addition to DEXA in certain groups (follow the link to see who they recommend this for).
What About Men?
Men develop osteoporosis later and less frequently than women (7% of men over age 65 vs. 30% of women). They are also correctly diagnosed and treated less frequently, even following a fragility fracture. There are no strong recommendations regarding DEXA screening in men, largely because of lack of evidence regarding outcomes. Many experts recommend screening when risk factors for osteoporosis are present.
Important risk factors include:
Age >70, low body weight (BMI <20 or 25)
Weight loss of 10%
Frailty
Prolonged glucocorticoid use
Androgen deprivation therapy (GnRH or orchiectomy)
Spinal cord injury