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

Updated: Aug 27, 2020
  • 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:

American Association of Clinical Endocrinologists 

The 2020 update of the American Association of Clinical Endocrinologists (AACE) guidelines recommends evaluation of all women age 50 or older for osteoporosis risk. The initial evaluation should include a detailed history, physical exam, and clinical fracture risk assessment with fracture risk assessment tool (FRAX®) or other fracture risk assessment tool. [12]

BMD should be considered, based on the patient's clinical fracture risk profile.  When bone mineral density is measured, axial dual-energy X-ray absorptiometry (DXA) measurement (lumbar spine and hip; 1/3 radius if indicated) is recommended. [12]

Other recommendations for BMD testing include the following [12] :

  • Women age 65 or older
  • Postmenopausal women with a history of fracture(s) without major trauma, with osteopenia identified radiographically, or starting long-term systemic glucocorticoid therapy (≥3 months)
  • Perimenopausal or postmenopausal women with risk factors for osteoporosis if willing to consider pharmacologic interventions, with low body weight (< 127 lb or body mass index < 20 kg/m 2, taking long-term systemic glucocorticoid therapy (≥3 months), or with a family history of osteoporotic fracture

Other indications for BMD tesing include the following [12] :

  • Early menopause
  • Current smoking history
  • Excessive consumption of alcohol
  • Secondary osteoporosis 

National Osteoporosis Foundation

The 2014 NOF guidelines recommend BMD measurement in the following patients [4] :

  • 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 [5] :

  • 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 [223]

  • 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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