New testing guidelines could lead to earlier treatment of osteoporosis
Osteoporosis is the most common bone disease in the U.S., leading to increased risk of fractures and a weakening of bone strength and structure. Now, new guidelines on who should be tested could lead to earlier treatment.
There are no symptoms of osteoporosis, and it’s usually found after a fracture. Screening is noninvasive and the updated guidelines now recommend all women over age 65 have a bone mineral density test. In addition, women of any age who may be at a higher risk of osteoporosis should also be tested.
The U.S. Preventive Services Task Force (USPSTF) regularly reviews each of its screening guidelines to ensure they are up to date with the most recent scientific evidence and expert opinion.
“The updated 2025 guidelines include that dual-energy X-ray absorptiometry (DXA) is the preferred modality of testing for bone mineral density in the evaluation for osteoporosis,” explains Dr. Lyn Weinberg, a geriatrician and Director, Division of Geriatrics, AHN Primary Care Institute. “This has always been generally accepted, but this is more specific than the 2018 guidelines, which recommend bone measurement testing without specifying the method.”
The 2025 updated guidelines also provide more specific guidance for postmenopausal women under the age of 65 by suggesting screening for osteoporosis risk factors and an assessment tool to determine if they should have DXA screening.
How does DXA work?
Dual-energy X-ray absorptiometry is the recommended screening method for osteoporosis. But how does it work?
“This low-radiation X-ray scan measures bone mineral density (BMD) in specific areas – typically the hip, thigh bone, lower spine, and sometimes forearm,” says Weinberg. “This provides a more accurate assessment of bone strength than standard X-rays, which only detect significant bone loss.”
The BMD score compares the individual’s bone density to that of a healthy young adult. A score of -2.5 or lower indicates osteoporosis and a significantly increased fracture risk. “Early detection through screening allows for timely intervention, reducing the risk of debilitating fractures and improving quality of life.”
As a geriatrician, Weinberg’s practice focuses on patients aged 65 and older.
“I encourage newly eligible 65-year-olds to begin osteoporosis screening immediately, in line with USPSTF guidelines,” she says. “Most of my patients readily accept DXA scans at age 65 and beyond. This low-risk, non-invasive test is quick and convenient, and typically covered by Medicare and Medicare Advantage, minimizing out-of-pocket expenses.”
Treating osteoporosis
A family of medications called bisphosphonates remains the first-line treatment for osteoporosis in most patients. “These medications effectively slow bone resorption and demonstrate a long-established safety and efficacy profile,” says Weinberg. “Oral bisphosphonates, such as alendronate (Fosamax) and ibandronate (Boniva), are administered weekly or monthly, respectively. Zoledronic acid (Reclast) is also available as a once-yearly intravenous option.” You may also have seen advertisements for denosumab (Prolia), another well-established treatment option for osteoporosis. Prolia is a twice-yearly injection that promotes bone formation.
“For patients with severe osteoporosis or a high fracture risk, newer agents such as teriparatide (Forteo), abaloparatide (Tymlos), and romosozumab (Evenity) offer alternative mechanisms of action to stimulate bone growth,” Weinberg says. “While cost and availability may currently limit broader access, these medications are increasingly utilized and often prescribed by specialists such as endocrinologists, rheumatologists or orthopedists.”
Promoting bone health
What can we do earlier in life to help prevent osteoporosis?
Both prevention and treatment involve several lifestyle changes, with regular exercise being paramount.
“Weight-bearing exercise, such as brisk walking, should be performed for at least 30 minutes most days of the week for postmenopausal women,” Weinberg said. “Incorporating muscle-strengthening and balance exercises, like resistance training or weightlifting, two to three times per week, further reduces fracture risk by minimizing falls.”
She also stressed that a diet rich in calcium (1,200 mg daily) and vitamin D (800 IU daily) is crucial. “While dairy products are a primary calcium source, supplementation may be necessary for some women to reach the recommended intake. Similarly, achieving the vitamin D target often requires supplementation. Adequate protein intake also supports bone and muscle health.”
Prevention is important since a fracture due to osteoporosis, particularly hip and spine fractures, can be extremely life-altering and even life-ending in very frail older adults. Osteoporosis can also cause microscopic spinal fractures leading to a hunched posture, causing pain and mobility issues.
“Early intervention, incorporating lifestyle modifications and medication as needed, is vital,” Weinberg says. “While the frequency of followup DXA scans after the initial test isn’t universally standardized, recommendations generally range from every two to five years, depending on individual risk factors and bone mineral density results. Women, as well as men with risk factors, should discuss personalized screening and treatment plans with their doctor.”