Choosing Wisely®

DEXA for Osteoporosis

Recommendation

Don't use dual-energy X-ray absorptiometry (DEXA) screening for osteoporosis in women under age 65 or men under 70 with no risk factors.

DEXA is not cost effective in younger, low-risk patients, but is cost effective in older patients.

Sources: U.S. Preventive Services Task Force (USPSTF), American Association of Clinical Endocrinology (AACE), American College of Preventive Medicine (ACPM), National Osteoporosis Foundation (NOF)


Supporting Information

In the United States, by 2012 approximately 12 million people over the age of 50 are expected to have osteoporosis.(1) The preferred method for diagnosing osteoporosis is  measuring bone mineral density (BMD) testing, which looks at important sites of osteoporotic fractures with high accuracy and moderate cost, and involves modest radiation exposure.(2) Guidelines from multiple organizations, including the American College of Obstetrics and Gynecology (ACOG) (2004), the U.S. Preventive Services Task Force (USPSTF), and the National Osteoporosis Foundation (NOF), recommend beginning duel-energy x-ray absorptiometry (DEXA) screening for osteoporosis at age 65 in women and men at age 70 with no risk factors.(3,4,5)

Risk factors for osteoporotic fractures include: a family history of osteoporosis, previous fractures, white race, dementia, poor nutrition, cigarette smoking, alcoholism, low weight and body mass index, estrogen deficiency, early menopause (i.e., before age 45) or prolonged premenopausal amenorrhea, long-term low calorie intake, history of falls, and inadequate physical activity.

Free online risk assessment calculators are available from the Foundation for Osteoporosis Research and Education and the World Health Organization (WHO). The user enters a patient’s age, BMD, height, weight, and other risk factors. The tool calculates the patient’s 10-year fracture risk and displays results for use in counseling the patient about osteoporosis management.

Risk Factors

  • Fracture from minor trauma
  • Rheumatoid arthritis
  • Low body mass index
  • Corticosteroid use (other medications as well)
  • Alcohol use or smoking history
  • Secondary causes of osteoporosis
  • Endocrine disorder
  • Physical inactivity

Recommendations for Prevention

  • Adequate calcium and vitamin D intake
  • Regular weight-bearing and muscle-strengthening exercise
  • Smoking cessation
  • Moderation of alcohol intake
  • Fall prevention strategies

References

  1. U.S. Preventive Services Task Force. Screening for osteoporosis in postmenopausal women. Recommendations and rationale. Rockville, Md.: Agency for Healthcare Research and Quality; 2002. AHRQ publication 03-511A. Available at http://www.uspreventiveservicestaskforce.org/3rduspstf/osteoporosis/osteorr.pdf(www.uspreventiveservicestaskforce.org). Accessed March 1, 2013.
  2. Osteoporosis guidelines issued. Bone health counseling begins in adolescence [news release]. Washington, DC: American College of Obstetricians and Gynecologists; August 21, 2012. Available at http://www.acog.org/About_ACOG/News_Room/News_Releases/2012/Osteoporosis_Guidelines_Issued(www.acog.org). Accessed November 21, 2012.
  3. National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2010. Available at http://nof.org/files/nof/public/content/file/344/upload/159.pdf(nof.org). Accessed March 1, 2013.
  4. U.S. Preventive Services Task Force. Screening for osteoporosis in postmenopausal women. Recommendations and rationale. Rockville, Md.: Agency for Healthcare Research and Quality; 2002. AHRQ publication 03-511A. Available at http://www.uspreventiveservicestaskforce.org/3rduspstf/osteoporosis/osteorr.pdf(www.uspreventiveservicestaskforce.org). Accessed March 1, 2013.
  5. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285:785–795.

This recommendation is provided solely for informational purposes and is not intended as a substitute for consultation with a medical professional. Patients with any specific questions about this recommendation or their individual situation should consult their physician.

About Choosing Wisely®

The Choosing Wisely®(www.choosingwisely.org)  campaign was created as an initiative of the American Board of Internal Medicine (ABIM) Foundation(www.abimfoundation.org) to improve health care quality. More than 50 specialty societies have identified commonly used tests or procedures within their specialties that are possibly overused.

Learn more about the AAFP support of the Choosing Wisely® campaign.