When to start screening with a DEXA scan? Your guide to bone density testing

According to the National Osteoporosis Foundation, approximately 10 million Americans have osteoporosis and another 44 million have low bone density, putting them at increased risk for fractures. Knowing when to start screening with a DEXA scan is a crucial step in proactively managing bone health and preventing serious issues later in life.

Quick Summary

For women, DEXA screening generally begins at age 65, while for men, it starts at 70, though both can begin earlier if certain risk factors are present. Personalized recommendations from a healthcare provider, considering individual health history and risk, are key to determining the optimal screening schedule.

Key Points

• Age-Based Screening: All women aged 65 and older and all men aged 70 and older are recommended to receive a DEXA scan for osteoporosis screening.

• Earlier Screening for Risk Factors: Postmenopausal women under 65 and men aged 50-69 with specific risk factors should discuss earlier screening with their healthcare provider.

• Common Risk Factors: Important factors that prompt earlier screening include a history of prior fractures, low body weight, certain medications, and chronic health conditions like rheumatoid arthritis.

• Interpreting T-Scores: DEXA scan results provide a T-score; a score of -1.0 or higher is normal, -1.0 to -2.5 indicates osteopenia, and -2.5 or lower indicates osteoporosis.

• Personalized Screening Intervals: How often you need a repeat DEXA scan depends on your initial results and risk profile, ranging from 1–2 years for high risk to potentially 10 years or more for those with normal bone density.

• Beyond the Scan: A comprehensive bone health strategy includes not only DEXA screening but also preventative measures like weight-bearing exercise, adequate calcium and vitamin D intake, and fall prevention.

Understanding the Importance of DEXA Screening

Bone density tests, most commonly using a dual-energy X-ray absorptiometry (DEXA or DXA) scan, are the standard for measuring bone mineral density. This non-invasive test helps diagnose osteoporosis before a fracture occurs. For older adults, particularly postmenopausal women and men over 70, fractures are a major health risk. A DEXA scan provides a bone density baseline to monitor changes and guide interventions.

Official Screening Guidelines by Age and Gender

Medical organizations offer guidelines for initiating DEXA scans based on age and common risk factors.

Women

For most women, screening starts based on age and menopause:

• Age 65 and older: Routine screening is recommended for all women aged 65 and older by organizations like the USPSTF and ACOG.
• Postmenopausal women under 65 with risk factors: Screening is advised if they have one or more risk factors for an osteoporotic fracture, assessed using tools like FRAX. Risk factors include low body weight, previous fracture, and family history.

Men

Osteoporosis affects men, especially in older age.

• Age 70 and older: Routine screening for men often begins at age 70.
• Men aged 50–69 with risk factors: Men in this age range with risk factors such as low testosterone, prolonged steroid use, smoking, or excessive alcohol should consider earlier screening.

Key Risk Factors That Warrant Earlier Screening

Beyond age, several factors increase osteoporosis risk and may require an earlier DEXA scan, sometimes as early as age 50. These include:

• Prior Fractures: A history of a fragility fracture indicates weakened bones.
• Low Body Weight: Individuals with a small, thin frame have less bone mass.
• Family History: A strong family history, especially a parent with a hip fracture, increases risk.
• Certain Medications: Long-term use of glucocorticoids, some antiseizure drugs, and proton pump inhibitors can affect bone health.
• Chronic Medical Conditions: Conditions like rheumatoid arthritis, celiac disease, and kidney or liver disease raise risk.
• Lifestyle Choices: Smoking, excessive alcohol, and inactivity negatively impact bone density.

What to Expect During a DEXA Scan

A DEXA scan is a simple, non-invasive procedure taking 10–30 minutes. You lie on a table while a scanner passes over your body, typically focusing on the hip and spine. It uses a very low dose of radiation. Afterward, you receive a T-score comparing your bone density to a healthy young adult, and possibly a Z-score comparing you to peers. These scores help your doctor interpret results.

What Do the DEXA Scan Results Mean?

The T-score is key to understanding your bone health:

• Normal: T-score is -1.0 or higher.
• Osteopenia: T-score is between -1.0 and -2.5 (low bone mass).
• Osteoporosis: T-score is -2.5 or lower (significant bone loss).

Navigating Screening Intervals

Subsequent scan frequency depends on results and risk factors. AAFP suggests those with a normal T-score and few risk factors may not need a repeat for up to 10 years. Individuals with osteopenia or osteoporosis need more frequent monitoring, possibly every 1–2 years for high risk or 3–5 years for moderate risk. Your healthcare provider will determine your personalized schedule.

The Role of Preventative Measures Beyond Screening

DEXA screening is vital, but healthy lifestyle habits are also crucial for bone strength.

A Comparison of Proactive Bone Health Strategies

Strategy	Description	Best For	Effectiveness
DEXA Scanning	Measures bone mineral density to diagnose osteopenia/osteoporosis early.	High-risk individuals, women over 65, men over 70.	Diagnostic, establishes baseline for monitoring.
Weight-Bearing Exercise	Activities like walking, running, and lifting weights that put stress on bones to stimulate growth.	All ages, but especially important for younger individuals reaching peak bone mass.	Proven to increase bone density and slow bone loss.
Calcium & Vitamin D Intake	Diet and supplements to ensure the body has the building blocks for healthy bones.	All ages, especially postmenopausal women and older adults.	Essential for bone health, but studies on supplements alone are mixed.
Fall Prevention	Strategies to reduce the risk of falling, such as balance training and home safety checks.	Older adults with osteoporosis or balance issues.	Highly effective in preventing fractures in at-risk populations.

Conclusion

Deciding when to start screening with a DEXA scan is a discussion with your doctor, considering your age, gender, and risk factors. DEXA scans are crucial for early osteoporosis detection and management. For many, screening starts at 65 for women and 70 for men, but risk factors can lead to earlier testing. Combining screening with a bone-healthy lifestyle protects your mobility as you age. For more bone health information, visit the Bone Health and Osteoporosis Foundation [https://www.bonehealthandosteoporosis.org].

Frequently Asked Questions

What is a DEXA scan and why is it important for senior care?

A DEXA scan is a medical test that measures bone mineral density. It is crucial for senior care because it helps diagnose osteoporosis and assess fracture risk before a serious injury occurs. Early detection allows for preventative treatment to maintain quality of life.

Are DEXA scans safe for older adults?

Yes, DEXA scans are very safe. They use a very low dose of radiation, far less than a standard chest X-ray, and the procedure is quick, painless, and non-invasive. The benefits of early diagnosis and prevention of fractures far outweigh the minimal risk.

Do men need DEXA scans for bone density, or is it just for women?

Men can also develop osteoporosis, especially as they age. While women are at higher risk, men over 70 should be screened, and men aged 50-69 with risk factors should discuss screening with their doctor. Screening is not just limited to women.

If my first DEXA scan is normal, how often do I need to be retested?

The interval for repeat screening depends on your T-score and risk factors. If your bone density is normal with few risk factors, you may not need another scan for 10 years or more. If you have osteopenia or high risk factors, repeat screening might be every 1–2 years, as determined by your physician.

What are the T-score ranges on a DEXA scan?

A T-score of -1.0 or higher is considered normal. A T-score between -1.0 and -2.5 is diagnosed as osteopenia, or low bone mass. A T-score of -2.5 or lower indicates osteoporosis.

What happens if a DEXA scan reveals osteopenia?

If your scan shows osteopenia, your doctor may recommend lifestyle changes such as diet adjustments, increased weight-bearing exercise, and calcium and vitamin D supplements. In some cases, medication may be considered to prevent further bone loss and the progression to osteoporosis.

How can I prepare for a DEXA scan?

Preparation is minimal. You should wear comfortable clothing and avoid wearing items with metal, such as zippers or buckles. You may be asked to avoid taking calcium supplements for 24 hours before the test. Inform your doctor if you are pregnant or have recently had a procedure with a contrast dye.