We recommend screening all women 65+ and all adults 50+ at increased risk of fractures and life expectancy >12 months. Risk factors include:

• Recent fracture history (past year), regardless of impact
• Increased fall risk (history of falls or scared of falling)
• Family history of osteoporosis or parent with hip fracture
• Chronic inflammatory disorder:
  • Rheumatoid arthritis
  • Inflammatory bowel disease
  • Many others
• Major organ disease:
  • Chronic liver/renal disease
  • Heart failure
  • COPD
  • Others
• Weight < 58 kg (127 lb)/10% weight loss
• Corticosteroids for 3+ months
• Current smoker
• Heavy alcohol use (3+ units daily)
• Risk for secondary osteoporosis
  • Severe Hypovitaminosis D (< 12 nm/mL)
  • Malabsorption (ie, Celiac disease, short gut syndrome, etc.)
  • Hyperthyroidism
  • Hypogonadism/premature menopause
  • Many others

PEARL: Don’t use DXA to screen for osteoporosis in a women younger than 65 or men younger than 70 with no risk factors (Choosing Wisely)