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)
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 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.
For Your Patients
Clinical Preventive Service Recommendation
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.
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.
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 70 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.
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DEXA for Osteoporosis - Choosing Wisely