Choosing Wisely report

Bone-density tests

When you need them—and when you don’t

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It’s worth getting a bone-density test if you’re older or have other risk factors for weak bones, because without it the first sign of osteoporosis is usually a broken bone. But if you’re not at higher risk, you should think twice about the test. Here’s why:

The test usually isn’t necessary in younger people without risk factors for weak bones.

Many women and some men are routinely screened for weak bones with an imaging test called a dual-energy X-ray absorptiometry (DEXA) scan. If it shows that you have outright osteoporosis, the results can help you and your doctor decide how to treat the problem, usually with drugs. But many people learn they have only mild bone loss, a condition known as osteopenia, and for them the risk of fracture is often quite low.

It can pose risks.

A DEXA scan isn’t likely to harm you directly. But a diagnosis of osteopenia can lead to treatment with such drugs as alendronate (Fosamax and generic), ibandronate (Boniva and generic), and risendronate (Actonel, Atelvia, and generic), which pose numerous risks. Those include thigh fractures; throat or chest pain; difficulty swallowing; heartburn; and more rarely, bone, eye, joint, and muscle pain; bone loss in the jaw; and possibly abnormal heart rhythm. In addition, there is little evidence that people with osteopenia get much benefit from the drugs. Other types of osteoporosis drugs are linked to risks such as blood clots, heart attacks, strokes, and serious infections.

It can be a waste of money.

A DEXA scan costs about $132, according to Though that isn’t as expensive as some tests, any money spent on unnecessary tests is money wasted. In addition, a month’s supply of generic alendronate costs $38 to $70. Fosamax, the brand-name version, costs $125 to $148. People often take the drugs for years and sometimes indefinitely.

So when is the test warranted?

Women should have their bone density measured at age 65. Men 70 and older might also want to talk with their doctor about the test. Women younger than 65 and men 50 to 69 should consider it if they have risk factors such as a fracture from minor trauma, rheumatoid arthritis, a parent who had a hip fracture, or a history of smoking, heavy drinking, or long-term use of corticosteroid drugs. Whether you need a follow-up bone-density test depends on the results of the initial scan.


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Published by Consumer Reports © 2012 Consumers Union of U.S., Inc., 101 Truman Ave., Yonkers, NY 10703-1057. Developed in cooperation with AAFP. Portions are derived from AAFP’s “Five Things Physicians and Patients Should Question” list. © 2012 AAFP. This list is based on the “The ‘Top 5’ Lists in Primary Care: Meeting the Responsibility of Professionalism,” the Good Stewardship Working Group, Arch Intern Med. 2011;171:1385-1390. “Top 5” Lists in Primary Care” were first published as part of the Less is More™ series in the Archives of Internal Medicine. © 2011 American Medical Association.