DEXA Scan Screening Guidelines

Standard Screening Ages

The American College of Radiology recommends that all women should begin routine DEXA screening at age 65 years, and all men should begin at age 70 years, regardless of risk factors 1, 2
Routine DEXA screening is recommended for all women at age 65 and older, with no additional risk factors required 3, 1, 2
Screening is NOT recommended for routine use in women younger than 65 without risk factors 1, 2
Routine DEXA screening is recommended for all men at age 70 and older 1, 2
Screening is NOT recommended for routine use in men younger than 70 without risk factors 1, 2

The American College of Radiology recommends earlier DEXA screening for postmenopausal women under 65 with previous fragility fracture, body weight less than 127 pounds, parental history of hip fracture, early menopause, or 10-year major osteoporotic fracture risk ≥9.3% as calculated by FRAX 1, 2, 3, 4
The Journal of the American College of Radiology recommends earlier DEXA screening for men under 70 and premenopausal women with hypogonadism, surgically/chemotherapeutically induced castration, or androgen deprivation therapy for prostate cancer 5, 1, 2
The American College of Radiology recommends earlier DEXA screening for individuals with medical conditions such as glucocorticoid therapy, chronic alcoholism, chronic renal failure, rheumatoid arthritis, eating disorders, organ transplantation, prolonged immobilization, or spinal cord injury 3, 5, 1, 2
The Journal of the American College of Radiology recommends earlier DEXA screening for individuals taking high-risk medications such as anticonvulsant drugs, aromatase inhibitor therapy, or chronic heparin therapy 5

The American College of Radiology recommends repeating DEXA in 2-3 years for individuals with normal bone density or mild osteopenia 1, 2
The American College of Radiology recommends repeating DEXA in 1-2 years to monitor treatment effectiveness for individuals with osteoporosis or on treatment 1, 2
The Journal of the American College of Radiology recommends repeating DEXA in 1-2 years for individuals at high risk for accelerated bone loss, such as those on glucocorticoid therapy or with spinal cord injury 5, 1

The American College of Radiology recommends avoiding screening women under 65 or men under 70 without documented risk factors, as this exposes patients to unnecessary radiation and costs without clinical benefit 1, 2
The American College of Radiology recommends not delaying screening in patients with chronic alcoholism, early menopause, or glucocorticoid use, as these conditions justify earlier screening regardless of age 2, 4
The American College of Radiology recommends not repeating DEXA scans more frequently than every 2 years in patients with normal BMD, as testing precision limitations make shorter intervals unreliable 1
The American College of Radiology recommends never repeating DEXA at intervals less than 1 year under any circumstances 1

The American College of Radiology recommends scanning both lumbar spine and bilateral hips, and using T-scores for all postmenopausal women regardless of age 3, 5, 4
The Journal of the American College of Radiology recommends using Z-scores for premenopausal women and men under 50 5
The American College of Radiology recommends considering Vertebral Fracture Assessment (VFA) during the same session for patients with T-score <-1.0 and additional risk factors 1

The American College of Physicians recommends that men under 70 with hypogonadism, androgen deprivation therapy, glucocorticoid use, previous fragility fracture, spinal cord injury, or chronic alcoholism should undergo DEXA screening 6
Individuals with low body mass index (<20-25 kg/m²), weight loss >10% compared with usual adult weight, or physical inactivity are at increased risk of osteoporosis and should be considered for earlier screening 6

By age 65 years, at least 6% of men have DXA-determined osteoporosis, making risk assessment before this age reasonable, according to the Annals of Internal Medicine 6
Men under 70 with specific risk factors, such as androgen deprivation therapy for prostate cancer, should undergo DEXA screening 6