NOF recommends considering vertebral x-rays in the following groups (who have not previously been diagnosed with osteoporosis):
In all women older than 70 or men older than 80.
In women age 65-69 and men age 75-79 who have T scores of -1.5.
In women age 50-64 and men age 50-74 who experience and fragility fracture, a historical height loss of 1.5 inches or a prospective height loss of 0.8 inches, recent or ongoing longterm glucocorticoid use.
Vertebral x-rays can demonstrate asymptomatic vertebral compression fractures, which make the diagnosis of osteoporosis. Some DEXA scanners are able to perform vertebral fracture analysis (VFA) from the DEXA images, eliminating the need for additional radiation exposure.