DEXA Scans for Prevention of Fragility Fractures

Choosing Wisely Canada recommendation #5: Do not order Dual-Energy X-ray Absorptiometry (DEXA) screening for prevention of fragility fractures in low-risk patients. Use “risk-assessment first” screening before ordering DEXA.

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Clinical scenario: A 67-year-old non-smoker with a BMI of 25 comes in for a simple mild rash. It is easily managed, which leaves extra time during the visit. During this time, the clinician reviews her chart and notices some screenings are outdated. Although the patient has no history of falls, fractures, or other risk factors for low bone density, the clinician orders a bone mineral densitometry (BMD) test based solely on her age.

This decision leads to time spent coordinating the scan, reviewing the results, and potentially explaining minor findings that would not warrant action, especially for a patient at low risk. The patient takes time off work, arranges transportation, completes forms, and undergoes a test she wasn’t expecting—adding burden and anxiety for a condition that posed little actual concern. Even when results are only mildly abnormal, being labeled with a diagnosis like osteopenia or osteoporosis can cause distress, influence self-perception, and lead to unnecessary follow-up or treatment in otherwise healthy individuals.

In a clinic of 10 clinicians, this translates to 7 days per year that could instead be allocated to more meaningful care. Depending on the setting, this time could support earlier access for patients with urgent concerns, longer visits for complex or multimorbid cases, preventive care planning, or interprofessional collaboration in both primary care and community health settings.