Women aged 65 and older should have a dual-energy X-ray absorptiometry (DXA) bone density test; postmenopausal women with osteoporosis risk factors need not wait until 65

39. Women aged 65 and older should have a dual-energy X-ray absorptiometry (DXA) bone density test; postmenopausal women with osteoporosis risk factors need not wait until 65

Cost: A hospital DXA scan of the lumbar spine and hip takes a few minutes lying down. Out-of-pocket cost is usually 100–200 yuan, varying by region. Heel ultrasound at a checkup can screen but cannot diagnose.

In plain terms: Women aged 65 and older, and postmenopausal women with osteoporosis risk factors, should have bone density measured once. When screening starts with fracture-risk assessment and treats those at high risk, hip fractures fall by about 17%. That works out to about 5 fewer hip fractures per 1,000 people screened. Overall mortality did not change.

Benefit: The U.S. Preventive Services Task Force 2025 recommendation is osteoporosis screening for women aged 65 and older (Grade B). Postmenopausal women under 65 at high fracture risk by assessment should also be screened (Grade B). Evidence for men is insufficient; no recommendation. The evidence review for that guidance pooled 3 randomized trials with 42,009 older European women. Screening meant assessing fracture risk first, measuring bone density in those at high risk, and treating those found high risk. Hip fractures in the screening group were about 17% lower (RR 0.83, 95% CI 0.73 to 0.93). In absolute terms, screening avoided 5 hip fractures per 1,000 people. In the UK SCOOP trial of 12,483 women aged 70 to 85, hip fractures in the screening group were about 28% lower (HR 0.72, 95% CI 0.59 to 0.89); mortality did not differ. The Chinese Medical Association 2017 guideline recommends DXA for women aged 65 and older and men aged 70 and older, and earlier when osteoporosis risk factors are present. In a 2017–2018 national survey, osteoporosis prevalence among adults over 40 was 20.6% in women and 5.0% in men (China).

Evidence grade: A

Sources: US Preventive Services Task Force, Nicholson WK, Silverstein M, et al. (2025). Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. <https://doi.org/10.1001/jama.2024.27154>; Kahwati LC, Kistler CE, Booth G, et al. (2025). Screening for Osteoporosis to Prevent Fractures: A Systematic Evidence Review for the US Preventive Services Task Force. JAMA. <https://doi.org/10.1001/jama.2024.21653>; Shepstone L, Lenaghan E, Cooper C, et al. (2018). Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. The Lancet. <https://doi.org/10.1016/S0140-6736(17)32640-5>; Chinese Society of Osteoporosis and Bone Mineral Research (2017). Guidelines for the Diagnosis and Management of Primary Osteoporosis (2017). Chinese Journal of Osteoporosis and Bone Mineral Research, 10(5), 413-443 (Table 5: Clinical Indications for Bone Mineral Density Measurement). <https://html.rhhz.net/GUSS/html/cc825127-29a3-47c1-9a95-7a212fdcce55.htm>; Wang L, Yu W, Yin X, et al. (2021). Prevalence of Osteoporosis and Fracture in China: The China Osteoporosis Prevalence Study. JAMA Network Open. <https://doi.org/10.1001/jamanetworkopen.2021.21106>

Notes: Controversy: SCOOP's prespecified primary outcome was all osteoporotic fractures; the screening group did not show a clear reduction (HR 0.94, 95% CI 0.85 to 1.03)—only hip fractures fell. All three trials used "assess risk, then measure bone density"; none compared bone density testing alone. The evidence review also estimated 11.8% to 24.1% overdiagnosis—people who would never have fractured from this cause in their lifetime. For men, the U.S. says evidence is insufficient; China's guideline sets age 70—follow your doctor. This item is about whether bone can survive a fall; avoiding falls themselves is item 13 (balance and leg strength)—do both. After osteoporosis is found, see item 40 (treat with medication). Primary beneficiaries are you and your parents.