Osteoporosis screening

Women 65 and older: all three recommend a scan. USPSTF (2025) grades it B, with moderate certainty of moderate net benefit. ACOG makes it a strong recommendation on high-quality evidence. BHOF lists women 65 and older for testing regardless of clinical risk factors. No body on this page sets an age to stop.

Postmenopausal women under 65: a scan only at increased risk, on all three positions, though each judges risk its own way (see below). USPSTF suggests two steps: first check for risk factors, which it names as menopausal status, low body weight, parental history of hip fracture, cigarette smoking and excess alcohol consumption; then, for a woman with 1 or more besides being postmenopausal, use a clinical risk assessment tool to decide whether a scan is warranted. ACOG requires a formal, validated risk tool. BHOF recommends testing postmenopausal women 50 to 64 with risk factors, and its Table 6 also names women in the menopausal transition.

Men: here the bodies split. USPSTF (2025) issues an I statement, insufficient evidence, because "there are no studies on the benefits and harms of screening for osteoporosis or fracture risk in men, and evidence on the benefits and harms of treatment is very limited." It says what the I does not mean: "The USPSTF wants to clarify that the I statement is not a recommendation against screening; it indicates that the evidence is insufficient to assess the balance of benefits and harms and is a call for more research." It leaves the decision to clinicians and patients together. BHOF (2022) recommends testing all men 70 and older regardless of risk factors, and men 50 to 69 with clinical risk factors for fracture. ACOG does not address men. USPSTF says men have fracture risk factors similar to women's, among them increasing age, low BMI, chronic corticosteroid use, a prior fracture and a fall within the past year.

Not covered by these rows: USPSTF's recommendations apply to adults 40 or older without known osteoporosis or a fragility fracture, and not to secondary osteoporosis from a medical condition or a medication such as glucocorticoids. BHOF recommends testing those groups on other grounds, including adults with a fracture at 50 or older and people taking glucocorticoids, aromatase inhibitors or androgen deprivation therapy. That is testing for a reason, not screening.

Under 65, the risk check comes before the scan. ACOG's sequence is a clinical examination (medical history, physical examination, height measurement), a formal risk assessment tool, then BMD testing where age or the tool's result calls for it. BHOF says every postmenopausal woman and every man 50 or older should be evaluated for risk first, and that a scan is not indicated unless the result will change treatment or management. Height loss counts: ACOG reports the National Osteoporosis Foundation (now BHOF) recommendation that patients who have lost 1.5 inches (4 cm) or more from their peak height at age 20, or 0.8 inches (2 cm) or more from a previously documented measurement, should have vertebral imaging.

The scan measures the hip and lumbar spine, which ACOG calls the most accurate and precise sites; ACOG and BHOF both fall back to the forearm when those cannot be measured, for example after both hips are replaced or after lumbar spine surgery. BHOF describes the radiation as trivial, and USPSTF says central DXA "uses low doses of radiation." BHOF notes that DXA of the lumbar spine can be difficult to interpret accurately. For a repeat scan, ACOG and BHOF both want the same machine; ACOG's reason is that DXA machines differ and need consistent calibration.

The result is a T-score, read against the WHO classes in BHOF's Table 4: normal at -1.0 and above, low bone mass (osteopenia) between -1.0 and -2.5, and osteoporosis at or below -2.5. BHOF adds that these classes do not apply to premenopausal women, men under 50 or children, who cannot be diagnosed on bone density alone.

A low result starts an evaluation, not an automatic prescription. USPSTF (2025): "To achieve the benefit of screening to reduce morbidity and mortality from fractures, women found to have osteoporosis should be further evaluated, counseled, and, if appropriate, prescribed evidence-based management." The drug therapies it lists as FDA-approved for treating or preventing osteoporosis are bisphosphonates, denosumab, romosozumab, parathyroid hormone, raloxifene, calcitonin, and estrogen with or without progesterone.

BHOF (2022) gives the points at which to consider drug treatment, for postmenopausal women and men 50 or older, to prevent a first fracture: a T-score of -2.5 or lower at the femoral neck, total hip, lumbar spine or 33% radius; or low bone mass, a T-score between -1.0 and -2.5 at the femoral neck or total hip, with a 10-year hip fracture risk of 3% or more or a 10-year major osteoporosis-related fracture risk of 20% or more on the US-adapted FRAX model. It says the thresholds "exist for guidance purposes only and are not absolute rules" and do not mandate treatment, particularly when bone mass is low but above the osteoporosis range, and that secondary causes of bone loss should be ruled out.

ACOG (2021, reaffirmed 2025) uses the same FRAX figures to define the disease. Its diagnostic criteria count any one of three as osteoporosis: a T-score of -2.5 or lower; a fragility fracture, including a vertebral fracture with no symptoms; or a T-score between -1.0 and -2.5 with increased fracture risk on a formal tool, which on US FRAX it puts at a 10-year hip fracture probability of 3% or greater or a major osteoporotic fracture probability of 20% or greater. So a scan read as osteopenia can still meet ACOG's definition of osteoporosis once fracture risk is counted, and an unexplained fragility fracture is diagnostic even with normal bone density. ACOG also says a tool such as FRAX can help decide on drug treatment in the osteopenia range, and that clinicians should assess fall risk in postmenopausal patients with low BMD or osteoporosis. ACOG covers treatment in a separate guideline, No. 2 (April 2022), which this page does not draw on.