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Osteoporosis Screening Guidelines: An Overview.

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Osteoporosis is commonly seen in women after menopause. This article explains different osteoporosis screening guidelines for early diagnosis and management.

Written by

Dr. Pallavi. C

Medically reviewed by

Dr. Anuj Gupta

Published At June 14, 2023
Reviewed AtJuly 17, 2023


Women are more likely than men to have osteoporosis, and half of all women will fracture due to osteoporosis during their lifetime. Exercise, assessing fall risk, and screening with bone density tests are important factors in keeping osteoporotic fractures at bay.

Why Is Osteoporosis Screening Required?

  • In order to reduce fractures, postmenopausal patients 65 years of age and older are advised to undergo a bone density examination. Using the fracture risk assessment tool, screening is advised for younger individuals with at least one risk factor if the fracture risk is higher than 8.4 percent.

  • Anorexia nervosa, diabetes mellitus types 1 and 2, reduced ovarian reserve or primary ovarian insufficiency, gastric bypass, HIV, hyperparathyroidism, hypocalcemia, premature menopause, renal impairment, rheumatoid arthritis, and more) can cause secondary bone loss. Other risk factors include smoking and a body mass index of less than 20 kilograms per square meter or a weight of less than 127 pounds (57.6 kilograms).

Hip and lumbar spine measurements of bone density are the most precise. Loss of height may reveal an undiagnosed vertebral fracture and a higher chance of a nonvertebral fracture. Vertebral imaging should be performed if a person loses 0.5-1 inch of height in three years or 1.5 inch from their early adult height. Regardless of bone density or the likelihood of vertebral fractures, a 2 inch height reduction increases the risk of hip and non-spine fractures by 60 percent.

  • The need for additional screening following normal bone density tests is still being determined. Despite the fact that the USPSTF does not address repeat screening and that there is limited data that suggests there is no benefit from rescreening sooner than four to eight years following a normal test, ACOG advises repeating testing no sooner than two years after the first screening in those who had a borderline result or experienced a change in risk factors, for patients receiving prolonged glucocorticoid therapy, a one-year follow-up exam is advised.

What Are Different Screening Recommendations?

National Osteoporosis Foundation (NOF)

The NOF advises taking a BMD (bone mineral density) and DXA (dual x-ray absorptiometry) measurement of the hip and spine in the following ways:

  • Regardless of clinical risk factors, women and men aged 65 and older are considered.

  • Postmenopausal women under 50, women going through menopause, and males aged 50 to 69 with clinical fracture risk factors.

  • Adults who have a fracture after turning 50.

  • Adults using glucocorticoids in a daily dose of less than 5 milligram of prednisone or an equivalent for less than three months who have a condition such as rheumatoid arthritis or are experiencing bone loss.

International Society Clinical Densitometry (ISCD)

The ISCD advises taking a BMD (DXA of the hip and spine) measurement in the following ways:

  • Regardless of risk factors, all men and women are 70 years and older.

  • Postmenopausal men and women between the ages of 50 and 70 who are exposed to risk factors.

  • The fragility of bone fracture in adults.

  • Adults with a disease or treatment are known to cause low bone mass or bone loss.

  • Any person under consideration for pharmacologic treatment for osteoporosis.

  • Anybody receiving osteoporosis treatment should keep track of their treatment's effectiveness.

  • Somebody who does not receive therapy when signs of bone loss require it.

  • If there is a specific risk factor, such as low body weight, a history of low-trauma fractures, or a high-risk drug, it may apply to women in the menopausal transition.

  • Testing for bone density should be considered for postmenopausal women who have stopped using estrogen.

  • In the following circumstances, the 33 percent forearm (one-third radius) location is advised:

    • When measuring or interpreting the hip and spine is not possible.

    • Hyperparathyroidism.

    • Acute obesity.

Association of Clinical Endocrinologists (AACE)

  • All women 65 years of age and older, according to the AACE, should have their BMD (DXA) measured.

  • Any adult with a fracture history that was not brought on by a serious injury.

  • Younger postmenopausal women who have fracture risk factors.

  • Measuring at the proximal femur and the lumbar spine (PA) is advised.

The USPSTF (United States Preventive Services Task Force)

USPSTF advises BMD measurements in:

  • Any woman 65 years of age and older.

  • They also advise screening in younger women whose fracture risk is comparable to or higher than that of a White woman 65 years old with no other risk factors.

  • Although the paper acknowledges the DXA of the hip is the strongest predictor of hip fracture, the ideal site to screen still needs to be addressed.

American Association of Family Doctors (AAFP)

The AAFP advises measuring BMD in the:

National Health Institutes (NIH)

  • The NIH advises BMD measurements for people at high risk for osteoporosis. They do not advocate for widespread screening.

North American Menopause Society (NAMS)

The NAMS advises BMD (DXA) measurement in:

  • Women over the age of 65.

  • Regardless of age, postmenopausal women with clinical risk factors for fracture or medical reasons of bone loss.

  • Ladies in postmenopause who have fractured their fragility.

American College of Preventive Medicine (ACPM)

The ACPM advises BMD (DXA) measurement in:

  • Women over the age of 65.

  • Men over the age of 70.

  • Postmenopausal individuals 50 to 69 years of age, particularly those with significant clinical fracture risk factors.

American College of Gynecology and Obstetrics (ACOG)

The ACOG advises BMD (DXA) measurements in:

  • Women over the age of 65.

  • Extra clinical fracture risk factors in women under 65.

  • Alternately, females younger than 65 with a FRAX 10-year risk of severe osteoporotic fracture of at least 9.3 percent.

National Osteoporosis Guidelines Group in the UK (NOGG)

Performing population screening is not advised by the NOGG. Results support the use of case-finding techniques for BMD assessments that are based on age-specific fracture probability thresholds.

Society for Canadian Osteoporosis

The Canadian Osteoporosis Society advises BMD measurement:

  • 65 and older postmenopausal females.

  • Men 65 years of age and older.

  • Younger people with additional clinical fracture risk factors.

How to Prevent Osteoporosis?

  • Exercise: Exercise aids bone preservation and is key to osteoporosis prevention advice. Exercises that involve resistance, heavy impact, or weight bearing are the most beneficial and secure for patients with osteopenia. Walking regularly could be helpful as well.

  • Medication: The National Academy of Medicine advises patients up to 70 to consume 600 International Unit of vitamin D daily through food and those above 70 to get 800 International Unit. For those under the age of 50, they advise 1,000 milligram of calcium daily; for those over 50, they advise 1,200 milligram.

  • Prevention of Fall: Fall-related fractures are common in osteoporosis patients, and specific risk factors increase the likelihood of falls. Patients with risk characteristics might benefit most from multifactorial therapies, such as physical or occupational therapy recommendations, cognitive behavior therapy, and dietary therapy. Workout programs help older persons experience fewer falls and fewer harmful falls. For community-dwelling individuals 65 years or older at elevated risk of falling, ACOG follows the USPSTF's recommendation to engage in physical activity.


Around 10 million Americans have osteoporosis, which will rise as the population ages. It is advised to maintain enough calcium and vitamin D levels, engage in regular weight-bearing activity, prevent falls, abstain from tobacco use, and consume moderate amounts of alcohol. Screening assists primary care physicians in choosing early therapies to reduce mortality and morbidity due to osteoporosis-related fractures, informing patients about their risks, and providing helpful information to support collaborative decision-making.

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Dr. Anuj Gupta
Dr. Anuj Gupta

Spine Surgery


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