SUMMARY:  

The USPSTF released recommendations update for osteoporosis screening to prevent fractures (2025).  The following guidelines are based upon an assessment of benefits vs harms and does not include cost analysis.

• USPSTF Recommendations
• Clinical risk factors in postmenopausal women <65 years of age
• Clinical risk assessment tools
• Screening Tests
• Additional Related USPSTF Recommendations
• Other Professional Recommendations

USPSTF Recommendations

Women ≥ 65 years and older 

• The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures (B recommendation)
  • Offer or provide this service
  • There is high certainty that the net benefit is substantial
  • DXA BMD reports may or may not include fracture risk assessment e.g. FRAX out of concern for validity of race specific FRAX calculators | lack of published RCTs utilizing FRAX alone 

Women <65 years and postmenopausal  

• The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women who are at increased risk, as determined by a formal clinical risk assessment tool (B recommendation)
  • Offer or provide this service
  • There is high certainty that the net benefit is substantial 
  • DXA BMD reports may or may not include fracture risk assessment e.g. FRAX out of concern for validity of race specific FRAX calculators | lack of published RCTs utilizing FRAX alone 
• The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men (I statement)
  • The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service
  • Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined

KEY POINTS:  

Clinical Risk Factors in Postmenopausal Women <65 Years of Age 

• If ≥1 risk factor, “a reasonable approach” is to use a clinical risk assessment tool (see below)  
• Clinical risk factors include
  • Parental history of hip fracture 
  • Smoking 
  • Excessive alcohol consumption 
  • Low body weight
  • Rheumatoid Arthritis 
  • Glucocorticoid use 

Clinical risk assessment tools 

• In the previous guideline (2018), FRAX was the clinical risk assessment tool of choice
  • Current (2025) guidance now includes others  
• The following tools perform similarly and are moderately accurate at predicting osteoporosis or risk of fracture and help risk stratify who may need DXA 
  • Osteoporosis Risk Assessment Instrument (ORAI) 
  • Osteoporosis Self-Assessment Tool (OST) 
  • FRAX tool (see “Learn More” below)

Screening Tests 

• Central DXA (most common)
  • Measures BMD at the hip and lumbar spine 
  • Used for most professional treatment guidelines (based on entry criteria for study enrollment) 

Additional Related USPSTF Recommendations 

• Preventing falls
  • The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years and older at increased risk of falls  
  • Selectively offer multifactorial interventions based on circumstances of prior falls, presence of comorbid medical conditions, and the patient’s values and preferences  
  • USPSTF recommends against Vitamin D supplementation to prevent falls 
• Preventing fractures
  • USPSTF recommends against supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium in postmenopausal women to prevent fractures 
  • The USPSTF found insufficient evidence on supplementation with higher doses of vitamin D and calcium, alone or combined, to prevent fractures in postmenopausal women, or at any dose in men and premenopausal women

Other Professional Recommendations 

• Bone Health and Osteoporosis Foundation
  • Recommends BMD testing in all women 65 years and older and all men 70 years and older 
  • Recommends BMD testing in postmenopausal women younger than 65 years and men aged 50 to 69 years based on their risk factor profile, including if they had a fracture as an adult
• American Academy of Family Physicians 
  • Recommends DXA screening in women 65 years or older 
  • Recommend DXA screening in women younger than 65 years with risk factors 
  •  Insufficient evidence to recommend screening in men 
• ACOG
  • Recommends BMD testing with DXA in postmenopausal patients 65 years and older
  • Recommends selective screening in postmenopausal women younger than 65 years who have osteoporosis risk factors as determined by formal clinical risk assessment tool
• American Association of Clinical Endocrinologists
  • Recommends evaluating all women 50 years and older for osteoporosis risk and considering BMD testing based on clinical fracture risk profile 
• Endocrine Society
  • Recommends screening in men older than 70 years  
  • Recommends screening adults
    • 50 to 69 years with significant risk factors 
    • Fracture after age 50 years

Learn More – Primary Sources:  

USPSTF Osteoporosis Screening Guidelines 2025 

FRAX Tool 

American Association of Clinical Endocrinologist 2020 Osteoporosis Guidelines 

ACOG Osteoporosis Screening Guidelines 

Bone Health and Osteoporosis Screening Guidelines 

Related PcMed Topics:

Fall Risk Evaluation and Prevention in Older Adults

ACP Releases Guidance Update on Osteoporosis Treatment

Osteoporosis Treatment for Postmenopausal Women at High Risk for Fracture