DEXA Scan Recommendations for Osteoporosis Screening

Primary Recommendation

The American College of Radiology recommends that all women aged 65 years and older should undergo routine DEXA screening of the lumbar spine and bilateral hips, with no additional risk factors required to justify the scan 3, 1, 2

Age alone is sufficient justification: Women ≥65 years receive routine screening regardless of any other clinical factors, and at 80 years old, this patient has been in the screening-eligible population for 15 years 1, 2
Vitamin D deficiency is an additional risk factor: The ACR Appropriateness Criteria specifically lists vitamin D deficiency as a condition that adversely affects bone mineral density and warrants DEXA evaluation 3, 4

Vertebral Fracture Assessment (VFA) should be performed during the same DEXA session if the patient has a T-score <-1.0, given that she meets age criteria (female ≥70 years) 3, 1
VFA can identify previously unrecognized vertebral fractures that independently increase future fracture risk 5
Studies show 60% of patients with vertebral fractures detected on VFA had bone density in the nonosteoporotic range, meaning they would have been missed by BMD measurement alone 5

Scan both lumbar spine (L1-L4) and bilateral hips as the standard protocol 3, 2
Use T-scores for interpretation (not Z-scores) since this is a postmenopausal woman 4, 2

If osteoporosis is diagnosed (T-score ≤-2.5) or treatment is initiated: Repeat DEXA in 1-2 years to monitor treatment effectiveness 1, 2
If normal bone density or mild osteopenia: Repeat DEXA in 2-3 years 1, 2

Do not delay scanning based on the presence or absence of symptoms: Osteoporosis is asymptomatic until fracture occurs, and age 80 is far beyond when screening should have been initiated 1, 2
Do not assume vitamin D supplementation alone is adequate without knowing bone density status: While vitamin D deficiency should be corrected, the patient's actual fracture risk and need for integral pharmacologic therapy cannot be determined without DEXA 3, 4