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Osteoporosis screening

2 recommendations USPSTF 2025 · BHOF 2022 Updated Sept. 25, 2026

Recommendations

USPSTF2025Grade B

Women ≥65: screen with bone density. Postmenopausal <65 at increased risk (clinical risk assessment, e.g. FRAX): screen. Men: insufficient evidence.

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BHOF2022

Bone density testing for women 65+ and men 70+ regardless of risk, for postmenopausal women and men 50 to 69 with risk factors, and after any adult fracture at 50+. Consider drug treatment for a hip or vertebral fracture, a T-score of -2.5 or lower, or osteopenia with a 10-year FRAX risk of hip fracture ≥3% or major osteoporotic fracture ≥20%.

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Who this applies to

  • Women 65 and older (USPSTF, January 2025, Grade B).
  • Postmenopausal women under 65 at increased risk (Grade B). The USPSTF suggests two steps: look for a risk factor such as low body weight, a parent with a hip fracture, smoking or excess alcohol, then use a risk tool such as FRAX to decide on a scan.
  • Men: insufficient evidence (I). The Bone Health and Osteoporosis Foundation advises testing men 70 and older, and men 50 to 69 with risk factors.
  • Risk factors that matter under 65: a parent with a hip fracture, low body weight, smoking, three or more drinks a day, rheumatoid arthritis, a fracture after 50, glucocorticoids for 3 months or longer, early menopause, aromatase inhibitors.

How it is done in practice

  • Central DXA of the hip and lumbar spine. A T-score of -2.5 or lower is osteoporosis; -1.0 to -2.5 is low bone mass. A hip or vertebral fragility fracture is osteoporosis whatever the T-score.
  • With low bone mass, the usual U.S. treatment threshold is a FRAX 10-year probability of hip fracture of 3 percent or more, or of major osteoporotic fracture of 20 percent or more.
  • USPSTF sets no repeat interval. Medicare covers DXA every 2 years. A stable normal scan in a younger woman can wait longer; a T-score near -2.0 or a new risk factor deserves an earlier recheck.
  • Historical height loss over 4 cm, or 2 cm measured between visits, calls for lateral spine imaging to find silent vertebral fractures.

What changed recently

The January 2025 update kept the 2018 grades, added the two-step approach for women under 65 (a risk factor first, then a risk tool), and noted that screening can be DXA with or without a fracture risk estimate. Men remain an evidence gap. It also stressed that screening should lead to a treatment discussion, not just a report.

Points that matter in clinic

  • A fragility fracture is a treatment indication on its own; do not wait for the scan. See the osteoporosis treatment page.
  • Baseline labs when osteoporosis is found: calcium, vitamin D, creatinine, TSH, CBC, and a metabolic panel; add celiac serology or a myeloma screen when the picture does not fit the age.
  • Steroid users deserve special attention: bone loss is fastest in the first 3 to 6 months of prednisone at 7.5 mg or more.

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