Women over 65 should get one dual-energy X-ray bone density scan, and after menopause, women with risk factors for osteoporosis shouldn't wait until 65
- Moderate value
- Evidence A
- Buys life
- Disputed
- For: Women + Age 35+, Elderly relative at home
- Costs a little
- Takes minutes
- No willpower
In plain words
Women over 65, and women after menopause who have risk factors for osteoporosis, should have their bone density checked once. Checking risk first and then treating the high-risk people reduces hip fractures by about 17%. In numbers, for every 1000 people screened, about 5 fewer have a hip fracture. No change in total death rate was seen.
- Cost
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One dual-energy X-ray absorptiometry (DXA) scan at a hospital, checking the lumbar spine and hip, takes a few minutes lying down. Out of pocket it is usually one or two hundred CNY, and prices vary by region. The heel ultrasound where you step on a device at a checkup is only a first screen and can't confirm the diagnosis.
- What you get
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The U.S. Preventive Services Task Force's 2025 recommendation is: screen women aged 65 and older for osteoporosis (grade B recommendation). Postmenopausal women under 65 who are judged by risk assessment to be at high risk of fracture are also recommended for screening (grade B). For men the evidence is insufficient, and it takes no position. The evidence review done for this recommendation pooled 3 randomized trials with 42009 older European women. Screening meant first assessing fracture risk, then measuring bone density in the high-risk, and treating those found at high risk. The screening group had about 17% fewer hip fractures (RR 0.83; 95% CI 0.73 to 0.93, the plausible range). In absolute terms, that is 5 fewer hip fractures per 1000 people screened. Among these, the U.K. SCOOP trial enrolled 12483 women aged 70 to 85, and the screening group had about 28% fewer hip fractures (HR 0.72, 95% CI 0.59 to 0.89), with no difference seen in death rate. The Chinese Medical Association's (中华医学会) 2017 guideline advises bone density testing for women over 65 and men over 70. Those younger than that but with one or more risk factors for osteoporosis are also advised to be tested. In the 2017 to 2018 national survey, the prevalence of osteoporosis in people over 40 was 20.6% in women and 5.0% in men (China).
- Notes
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Disputed: the main outcome SCOOP set in advance was all osteoporotic fractures, and the screening group did not clearly have fewer (HR 0.94, 95% CI 0.85 to 1.03); only hip fractures were fewer. All three trials were “assess risk first, then measure bone density”; none compared bone density testing alone. The evidence review also estimated that 11.8% to 24.1% of people found were overdiagnosed, meaning people who would not have had a fracture in their lifetime anyway. Whether men should be tested: the U.S. says the evidence is insufficient, while Chinese guidelines set it at over 70, so follow your doctor's advice. This item is about whether the bones can withstand a fall; falling less depends on §1.13 (balance and leg strength), and the two should be done together. For what to do once osteoporosis is found, see §1.40 (take medicine if osteoporosis is found). The beneficiary is mainly you, and also your parents.
- Evidence grade
- A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.
- Sources
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- 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
- 中华医学会骨质疏松和骨矿盐疾病分会 (2017). 原发性骨质疏松症诊疗指南(2017). 中华骨质疏松和骨矿盐疾病杂志, 10(5), 413-443（表 5 骨密度测量的临床指征）. 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
Mentioned in
- After 60, train balance and leg strength, and make the bathroom and stairs at home safer
- If osteoporosis is found, or you have broken a bone from a light fall, ask a doctor to prescribe an anti-osteoporosis drug and keep using it; calcium supplements are not a substitute
- If hot flashes and night sweats around menopause are affecting your life, see a gynecologist about hormone therapy; don't just put up with it, don't buy the drugs yourself, and don't use it to prevent heart disease
- Don't rely on a general checkup package to prevent disease; get the few screenings that have evidence for your age and sex
- If an older person's cataract already affects seeing the way, go to an eye doctor for an assessment and surgery; if both eyes have it, don't delay the second one too long
- If an older person walks a dog, hold the leash in the palm of the hand and don't wrap it around the hand, keep the leash short, and first train the dog not to lunge forward on the leash
Translated from the Chinese original. Original book, section 1, tip 39. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer