Not Everyone Needs A Bone Density Scan

DEXA scans recommended for older population and those with high risk factors

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Detection of osteoporosis is important for treating and preventing bone fractures. But when it comes to bone density testing for osteoporosis, more isn’t always better.

A not-for-profit organization established by the American Board of Internal Medicine has joined with leading medical groups to develop lists of tests and procedures for patients to discuss with their physicians as part of a campaign called Choosing Wisely®.

When it comes to osteoporosis, the foundation recommended bone density testing for women above 65 and men above 70 or for those who have other risk factors for weak bones.

Younger patients who exhibit certain risk factors should also undergo bone density scanning.

"Ask your doctor whether bone density scanning is right for you."

The campaign combined efforts from Consumer Reports, the American Academy of Family Physicians and other groups. The document describes osteoporosis, when bone density testing is appropriate and how to keep bones strong.

According to Choosing Wisely®, many women and men are often unnecessarily screened for weak bones using a dual energy X-ray absorptiometry scan (DEXA). While it is important for those with osteoporosis to be properly diagnosed, people often discover through DEXA that they have osteopenia, a low risk condition characterized by mild bone loss.

While DEXA itself is not harmful, the authors of the document noted that drugs to treat osteopenia carry risks. These medications may have side effects that include thigh fractures, throat or chest pain, difficulty swallowing and heartburn. Some of these are alendronate (Fosamax and generic), ibandronate (Boniva and generic), and risendronate (Actonel, Atelvia, and generic).

Choosing Wisely® also advised that DEXA scans and the resulting treatment are costly. According to HealthCareBlueBook.com, a DEXA scan costs about $132 and a month’s supply of medication for the low risk condition of osteopenia can cost between $38 and $148.

While the campaign recommended bone density scans for women over age 65 and men over age 70, women younger than 65 and men between age 50 and 69 should consider the scan if they have certain risk factors. These risk factors include fracture from minor trauma, rheumatoid arthritis, a parent who had a hip fracture and history of smoking, drinking and long-term use of corticosteroid drugs.

Follow-up scans were recommended for those whose initial scans have signaled that it is necessary.

"Those who benefit most from a test are those who have a higher degree of risk before taking it," Steven Kussin, MD, FACP, patient advocate and author of Doctor, Your Patient Will See You Now, told dailyRx.

"For a post menopausal woman without a history of fractures the chance of overtreatment for borderline DEXA results is high," said Dr. Kussin

The study authors recommended the following strategies to protect against fractures:

  • Do weight-bearing exercises for at least 30 minutes a day
  • Get enough calcium and vitamin D
  • Avoid smoking and excessive alcohol
  • Minimize medication that is damaging to bones.
  • Reduce risks of falling from your environment

"It is welcome news when Choosing Wisely focused on osteoporosis," added Dr. Kussin. "There are few areas in medicine associated with more controversy."

Reviewed by: 
Review Date: 
February 28, 2013
Last Updated:
March 5, 2013