What are the guidelines for screening patients for osteoporosis with bone mineral density (BMD) measurement?

Updated: Sep 26, 2019
  • Author: Monique Bethel, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

The following organizations have issued recommendations on measurement of bone mineral density (BMD) for osteoporosis screening:

National Osteoporosis Foundation

The 2014 NOF guidelines recommend BMD measurement in the following patients [2] :

  • Women age 65 years and older and men age 70 years and older, regardless of clinical risk factors

  • Younger postmenopausal women and women in menopausal transition with clinical risk factors for fracture

  • Men age 50-69 years with clinical risk factors for fracture

International Society  for Clinical Densitometry

The 2015 ISCD Official Positions recommend bone density testing in the following patients [3] :

  • Women aged 65 and older

  • Postmenopausal women younger than age 65 with a risk factor for low bone mass (eg, low body weight, prior fracture, high-risk medication use, disease or condition associated with bone loss)

  • Women during the menopausal transition with clinical risk factors for fracture (eg, low body weight, prior fracture, high-risk medication use)

  • Men age 70 years and older

  • Men younger than 70 years with a risk factor for low bone mass (eg, low body weight, prior fracture, high-risk medication use, disease or condition associated with bone loss)

  • Adults with a fragility fracture

  • Adults with a disease or condition associated with low bone mass or bone loss

  • Adults taking medications associated with low bone mass or bone loss

  • Anyone being considered for pharmacologic therapy

  • Anyone being treated, to monitor treatment effect

  • Anyone not receiving therapy in whom evidence of bone loss would lead to treatment

Women discontinuing estrogen should be considered for bone density testing according to the indications listed above.

US Preventive Services Task Force

The USPSTF recommends measuring BMD in the following patients [226, 225]

  • Women age 65 years and older 

  • Postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool

Suggested risk assessment tools include the following:

  • Fracture Risk Assessment Tool (FRAX)
  • Simple Calculated Osteoporosis Risk Estimation (SCORE)
  • Osteoporosis Risk Assessment Instrument (ORAI)
  • Osteoporosis Index of Risk (OSIRIS)
  • Osteoporosis Self-Assessment Tool (OST)

In contrast to the NOF and ISCD, the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening to prevent osteoporotic fractures in men.


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