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Osteoporosis: Should I Have a Dual-Energy X-Ray Absorptiometry (DXA) Test?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Osteoporosis: Should I Have a Dual-Energy X-Ray Absorptiometry (DXA) Test?

Get the facts

Your options

  • Have the DXA test to find out whether you need treatment for osteoporosis.
  • Don't have the test.

Key points to remember

  • It's important to know if you are at risk for osteoporosis. The DXA test measures bone thickness to find out if you have osteoporosis or if you are at risk for a broken bone (fracture).
  • The United States Preventive Services Task Force (USPSTF) recommends that women age 65 or older have routine tests to measure their bone thickness. If you are at increased risk for fractures caused by osteoporosis, routine screening should start sooner.1
  • Experts suggest that older men talk to their doctors about osteoporosis and have a bone density test if they are at risk.2
  • You probably don't need this test if:
    • You are at low risk for osteoporosis and are younger than 65.
    • You have osteoporosis but are not willing to make lifestyle changes or take medicines to treat it.
  • The test may be a good choice for you if you are at risk for osteoporosis and are willing to make lifestyle changes and take medicines to treat it.
FAQs

What is osteoporosis?

Osteoporosis is a disease that affects your bones. It means that your bones are thin and brittle, with lots of holes inside them like a sponge. This makes them easy to break. Osteoporosis can lead to broken bones (fractures) in the hip, spine, wrist, and other parts of your body. These fractures can be disabling and may make it hard for you to live on your own.

What is the DXA test?

The DXA is an X-ray test that measures bone thickness. It is used to see if your bones are getting thin and brittle, which means they could break more easily.

The results of the test may show that you need treatment for osteoporosis.

What can increase your risk for osteoporosis?

A risk factor is anything that can increase your risk of getting a disease. Some risk factors you can change so that you reduce your risk. Others you can't change.

Risk factors you can't change include:

  • Your age. Your risk for osteoporosis goes up as you get older.
  • Being a woman who has gone through menopause. After menopause, your body makes less estrogen. Estrogen protects the body from bone loss.
  • Your family history. Osteoporosis tends to run in families.
  • Having a slender body frame.
  • Your race. People of European and Asian background are most likely to get osteoporosis.
  • Your health. You may be at higher risk if you have a medical problem such as hyperthyroidism that makes it hard for your body to absorb enough calcium.
  • Having surgery to remove your ovaries before menopause.

Risk factors you can change include:

  • Smoking.
  • Not getting enough weight-bearing exercise, such as running, walking, or lifting weights.
  • Drinking large amounts of alcohol.
  • Not getting enough calcium and vitamin D.
  • Using steroid medicines for 6 months or longer. But you may not be able to stop taking these, depending on why you are taking them.

Who should get a bone density test?

The United States Preventive Services Task Force (USPSTF) recommends that women age 65 or older have routine tests to measure their bone thickness. If you are at increased risk for fractures caused by osteoporosis, routine screening should start sooner.1 USPSTF recommends that you and your doctor check your fracture risk using a tool such as FRAX to help decide whether you should be screened for osteoporosis. Talk to your doctor about your risk factors and when to start bone density screening.

The FRAX tool was developed by the World Health Organization to help predict your risk of having a fracture related to osteoporosis in the next 10 years. You can use this tool. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can type in your score. If you have not had that test, you can leave the score blank.

Here are some other things to think about:

  • You may also want to have this test if you have a low-trauma fracture. Low trauma means that you broke a bone doing something that would not normally cause a broken bone, such as a simple fall.
  • Experts suggest that older men talk to their doctors about osteoporosis and have a bone density test if they are at risk.2
  • Your doctor may want you to have a follow-up bone density test after you have been on treatment. If this is suggested for you, it is done no more than every 2 years. Getting follow-up tests doesn't make your treatment work better.

What can you expect if you get a bone density test?

If you have risk factors for osteoporosis and choose to get the test, the results can help you make decisions about treatment. Treatment can help strengthen bones and prevent fractures.

What can you expect if you do NOT get a bone density test?

If you are younger than 65 and don't have any risk factors for osteoporosis, this test won't be very useful. You may want to have the test when you reach age 65. But in the meantime, if you are worried about getting osteoporosis, talk with your doctor about lifestyle changes you can make to keep your bones strong.

If you are at risk for osteoporosis and have a healthy lifestyle but are not willing to take medicines for treatment, the test may not be helpful. The results of the test would not change what you are already doing to keep your bones strong.

Why might your doctor recommend a DXA test?

Your doctor may advise you to get this test if:

  • You are 65 or older and have other risk factors for osteoporosis.
  • You are willing to make changes to your lifestyle or take medicines if the test shows that you have osteoporosis.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have the DXA test Have the DXA test
  • The DXA test is done in a radiology department or clinic. It takes about 20 minutes.
  • X-rays are taken of the hip and spine to measure bone thickness.
  • The test measures bone thickness. It can help show if you are at risk for having broken bones (fractures) because of osteoporosis, and it can help guide decisions about treatment.
  • During the X-ray test, you are exposed to a very low dose of radiation.
  • The test is not recommended for pregnant women because of radiation exposure to the developing baby.
Don't have the test Don't have the test
  • You may talk with your doctor about your risk factors.
  • If you are worried about osteoporosis, you can adopt healthy habits such as quitting smoking and getting more weight-bearing exercise.
  • You avoid the costs of the test.
  • You may be at risk for broken bones from osteoporosis and not know it.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about deciding whether to have a bone density test

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I am uncertain about taking medicines for osteoporosis. I have a few risk factors for osteoporosis, but not many. I think that knowing my bone density would give me at least one objective piece of information I can use to make the medicine decision. It would also give me a baseline, so if I'm tested again in the future I can tell if my bone density has changed.

Janet, age 65

I have a number of risk factors for osteoporosis, and I have watched my mother's struggle with spinal fractures over the past few years. In her day, they didn't know as much about using hormones after menopause to prevent "brittle bones." I already take calcium and vitamin D and have already decided that I will take osteoporosis medicine, so my doctor and I agree that for now there is no real reason for me to have a bone density test.

Annamaria, age 51

I slipped on the ice last week and broke my wrist. It didn't seem like a very serious fall, and the doctor said that because of my age, she wondered if perhaps I might have osteoporosis. I had decided not to take hormones when I went through menopause, and I probably haven't been getting quite as much calcium as I should. I am going to have the bone density test and see if maybe I have osteoporosis. I hear there are some medicines that can help treat it. And either way, I will definitely start taking my calcium supplements.

Elsie, age 71

I was surprised to find that I don't have any risk factors for osteoporosis other than getting older. And I've always enjoyed drinking milk, so I don't have a problem getting enough calcium. I exercise, and I don't smoke or drink. Really, I think my bones are healthy! I'm not taking hormones after menopause, and I feel like I am at such low risk of getting osteoporosis that the bone density test isn't something I need at this point. I'm going to talk it over with my doctor.

Sharon, age 55

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a DXA test

Reasons not to have a DXA test

I think I'm at risk for osteoporosis, and I want to know for sure.

I don't think I'm at risk for osteoporosis.

More important
Equally important
More important

I'm willing to make lifestyle changes and take medicines if I am at risk.

I'm not willing to make any changes or take medicines.

More important
Equally important
More important

The cost of the test doesn't bother me.

I'm worried about the cost of the test.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having the test

NOT having the test

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Is getting the bone density test a good choice for everyone?

  • YesSorry, that's not right. You probably don't need this test if you are at low risk for osteoporosis and are younger than 65.
  • NoYou're right. You probably don't need this test if you are at low risk for osteoporosis and are younger than 65.
  • I'm not sureIt may help to go back and read "Get the Facts." You probably don't need this test if you are at low risk for osteoporosis and are younger than 65.
2.

Is it important to know your risk for osteoporosis?

  • YesYou're right. It is important to know your risk for osteoporosis. But you can find out without getting a bone density test.
  • NoSorry, that's not right. It's important to know your risk for osteoporosis. But you can find out without getting a bone density test.
  • I'm not sureIt may help to go back and read "Get the Facts." It's important to know your risk for osteoporosis. But you can find out without getting a bone density test.
3.

Is the test recommended for any woman age 65 or older?

  • YesYou're right. The U.S. Preventive Services Task Force recommends routine bone testing for women 65 or older.
  • NoSorry, that's not right. The U.S. Preventive Services Task Force recommends routine bone testing for women 65 or older.
  • I'm not sureIt may help to go back and read "Get the Facts." The U.S. Preventive Services Task Force recommends routine bone testing if you are 65 or older.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Credits Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Carla J. Herman, MD, MPH - Geriatric Medicine

References
Citations
  1. U.S. Preventive Services Task Force (2011). Screening for Osteoporosis: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf10/osteoporosis/osteors.htm.
  2. Qaseem A, et al. (2008). Screening for osteoporosis in men: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 148(9): 680–684. Also available online: http://www.acponline.org/clinical_information/guidelines/guidelines.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Osteoporosis: Should I Have a Dual-Energy X-Ray Absorptiometry (DXA) Test?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have the DXA test to find out whether you need treatment for osteoporosis.
  • Don't have the test.

Key points to remember

  • It's important to know if you are at risk for osteoporosis. The DXA test measures bone thickness to find out if you have osteoporosis or if you are at risk for a broken bone (fracture).
  • The United States Preventive Services Task Force (USPSTF) recommends that women age 65 or older have routine tests to measure their bone thickness. If you are at increased risk for fractures caused by osteoporosis, routine screening should start sooner.1
  • Experts suggest that older men talk to their doctors about osteoporosis and have a bone density test if they are at risk.2
  • You probably don't need this test if:
    • You are at low risk for osteoporosis and are younger than 65.
    • You have osteoporosis but are not willing to make lifestyle changes or take medicines to treat it.
  • The test may be a good choice for you if you are at risk for osteoporosis and are willing to make lifestyle changes and take medicines to treat it.
FAQs

What is osteoporosis?

Osteoporosis is a disease that affects your bones . It means that your bones are thin and brittle, with lots of holes inside them like a sponge. This makes them easy to break. Osteoporosis can lead to broken bones (fractures) in the hip, spine, wrist, and other parts of your body. These fractures can be disabling and may make it hard for you to live on your own.

What is the DXA test?

The DXA is an X-ray test that measures bone thickness. It is used to see if your bones are getting thin and brittle, which means they could break more easily.

The results of the test may show that you need treatment for osteoporosis.

What can increase your risk for osteoporosis?

A risk factor is anything that can increase your risk of getting a disease. Some risk factors you can change so that you reduce your risk. Others you can't change.

Risk factors you can't change include:

  • Your age. Your risk for osteoporosis goes up as you get older.
  • Being a woman who has gone through menopause. After menopause, your body makes less estrogen. Estrogen protects the body from bone loss.
  • Your family history. Osteoporosis tends to run in families.
  • Having a slender body frame.
  • Your race. People of European and Asian background are most likely to get osteoporosis.
  • Your health. You may be at higher risk if you have a medical problem such as hyperthyroidism that makes it hard for your body to absorb enough calcium.
  • Having surgery to remove your ovaries before menopause.

Risk factors you can change include:

  • Smoking.
  • Not getting enough weight-bearing exercise, such as running, walking, or lifting weights.
  • Drinking large amounts of alcohol.
  • Not getting enough calcium and vitamin D.
  • Using steroid medicines for 6 months or longer. But you may not be able to stop taking these, depending on why you are taking them.

Who should get a bone density test?

The United States Preventive Services Task Force (USPSTF) recommends that women age 65 or older have routine tests to measure their bone thickness. If you are at increased risk for fractures caused by osteoporosis, routine screening should start sooner.1 USPSTF recommends that you and your doctor check your fracture risk using a tool such as FRAX to help decide whether you should be screened for osteoporosis. Talk to your doctor about your risk factors and when to start bone density screening.

The FRAX tool was developed by the World Health Organization to help predict your risk of having a fracture related to osteoporosis in the next 10 years. You can use this tool. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can type in your score. If you have not had that test, you can leave the score blank.

Here are some other things to think about:

  • You may also want to have this test if you have a low-trauma fracture. Low trauma means that you broke a bone doing something that would not normally cause a broken bone, such as a simple fall.
  • Experts suggest that older men talk to their doctors about osteoporosis and have a bone density test if they are at risk.2
  • Your doctor may want you to have a follow-up bone density test after you have been on treatment. If this is suggested for you, it is done no more than every 2 years. Getting follow-up tests doesn't make your treatment work better.

What can you expect if you get a bone density test?

If you have risk factors for osteoporosis and choose to get the test, the results can help you make decisions about treatment. Treatment can help strengthen bones and prevent fractures.

What can you expect if you do NOT get a bone density test?

If you are younger than 65 and don't have any risk factors for osteoporosis, this test won't be very useful. You may want to have the test when you reach age 65. But in the meantime, if you are worried about getting osteoporosis, talk with your doctor about lifestyle changes you can make to keep your bones strong.

If you are at risk for osteoporosis and have a healthy lifestyle but are not willing to take medicines for treatment, the test may not be helpful. The results of the test would not change what you are already doing to keep your bones strong.

Why might your doctor recommend a DXA test?

Your doctor may advise you to get this test if:

  • You are 65 or older and have other risk factors for osteoporosis.
  • You are willing to make changes to your lifestyle or take medicines if the test shows that you have osteoporosis.

2. Compare your options

  Have the DXA test Don't have the test
What is usually involved?
  • The DXA test is done in a radiology department or clinic. It takes about 20 minutes.
  • X-rays are taken of the hip and spine to measure bone thickness.
  • You may talk with your doctor about your risk factors.
  • If you are worried about osteoporosis, you can adopt healthy habits such as quitting smoking and getting more weight-bearing exercise.
What are the benefits?
  • The test measures bone thickness. It can help show if you are at risk for having broken bones (fractures) because of osteoporosis, and it can help guide decisions about treatment.
  • You avoid the costs of the test.
What are the risks and side effects?
  • During the X-ray test, you are exposed to a very low dose of radiation.
  • The test is not recommended for pregnant women because of radiation exposure to the developing baby.
  • You may be at risk for broken bones from osteoporosis and not know it.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about deciding whether to have a bone density test

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I am uncertain about taking medicines for osteoporosis. I have a few risk factors for osteoporosis, but not many. I think that knowing my bone density would give me at least one objective piece of information I can use to make the medicine decision. It would also give me a baseline, so if I'm tested again in the future I can tell if my bone density has changed."

— Janet, age 65

"I have a number of risk factors for osteoporosis, and I have watched my mother's struggle with spinal fractures over the past few years. In her day, they didn't know as much about using hormones after menopause to prevent "brittle bones." I already take calcium and vitamin D and have already decided that I will take osteoporosis medicine, so my doctor and I agree that for now there is no real reason for me to have a bone density test."

— Annamaria, age 51

"I slipped on the ice last week and broke my wrist. It didn't seem like a very serious fall, and the doctor said that because of my age, she wondered if perhaps I might have osteoporosis. I had decided not to take hormones when I went through menopause, and I probably haven't been getting quite as much calcium as I should. I am going to have the bone density test and see if maybe I have osteoporosis. I hear there are some medicines that can help treat it. And either way, I will definitely start taking my calcium supplements."

— Elsie, age 71

"I was surprised to find that I don't have any risk factors for osteoporosis other than getting older. And I've always enjoyed drinking milk, so I don't have a problem getting enough calcium. I exercise, and I don't smoke or drink. Really, I think my bones are healthy! I'm not taking hormones after menopause, and I feel like I am at such low risk of getting osteoporosis that the bone density test isn't something I need at this point. I'm going to talk it over with my doctor."

— Sharon, age 55

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a DXA test

Reasons not to have a DXA test

I think I'm at risk for osteoporosis, and I want to know for sure.

I don't think I'm at risk for osteoporosis.

             
More important
Equally important
More important

I'm willing to make lifestyle changes and take medicines if I am at risk.

I'm not willing to make any changes or take medicines.

             
More important
Equally important
More important

The cost of the test doesn't bother me.

I'm worried about the cost of the test.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having the test

NOT having the test

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Is getting the bone density test a good choice for everyone?

  • Yes
  • No
  • I'm not sure
You're right. You probably don't need this test if you are at low risk for osteoporosis and are younger than 65.

2. Is it important to know your risk for osteoporosis?

  • Yes
  • No
  • I'm not sure
You're right. It is important to know your risk for osteoporosis. But you can find out without getting a bone density test.

3. Is the test recommended for any woman age 65 or older?

  • Yes
  • No
  • I'm not sure
You're right. The U.S. Preventive Services Task Force recommends routine bone testing for women 65 or older.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Carla J. Herman, MD, MPH - Geriatric Medicine

References
Citations
  1. U.S. Preventive Services Task Force (2011). Screening for Osteoporosis: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf10/osteoporosis/osteors.htm.
  2. Qaseem A, et al. (2008). Screening for osteoporosis in men: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 148(9): 680–684. Also available online: http://www.acponline.org/clinical_information/guidelines/guidelines.

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