Osteoporosis Screening in Primary Care: A Quick NP Guide

Osteoporosis is often silent until a fracture occurs — and by then, it’s too late. As new nurse practitioners in primary care, understanding who to screen and how to interpret results is essential. Here’s a no-fluff, step-by-step guide you can use in clinic.

Who Needs Screening?

Women

• Age ≥65 → Screen all women with a DEXA scan.

• Age <65 → Screen if they have risk factors: low body weight, smoking, family history of fracture, early menopause, chronic glucocorticoid use.

Men

• Routine screening not universally recommended.

• Consider DEXA for men ≥70, or younger if high risk (steroids, hypogonadism, chronic illness, low-trauma fracture).

Interpreting DEXA Results

DEXA gives you a T-score (compares to young healthy adult) and a Z-score (compares to age-matched).

• Normal: T-score ≥ -1.0

• Osteopenia: T-score -1.0 to -2.5

• Osteoporosis: T-score ≤ -2.5

📌 Clinical Pearl: Always check if Z-score is low (< -2.0) → this suggests a secondary cause (not just age-related).

How Often to Repeat Screening

• Normal bone density or mild osteopenia: Every 5–10 years.

• Moderate osteopenia: Every 2–3 years.

• Osteoporosis or on therapy: Every 2 years (sooner if clinically indicated).

Don’t Miss Secondary Causes

Before labeling it “just osteoporosis,” think about:

• Endocrine: Hyperthyroidism, hyperparathyroidism, Cushing’s.

• Nutritional: Vitamin D deficiency, malabsorption, celiac disease.

• Medications: Chronic steroids, aromatase inhibitors, anticonvulsants, SSRIs.

• Other: CKD, chronic liver disease, rheumatoid arthritis.

Tools to Refine Risk

• FRAX Score → Calculates 10-year fracture risk (hip + major osteoporotic fracture).

• Helps decide if a patient with osteopenia still needs treatment.

• Clinical pearl: FRAX works best in patients aged 40–90 and without prior osteoporosis therapy.

Takeaway for New Nurse Practitioners

Screening for osteoporosis is about catching risk early before fractures happen.

• Women ≥65? Get a DEXA.

• Younger women and men? Use risk factors and clinical judgment.

• Always consider secondary causes and use FRAX to guide treatment decisions.

With a structured workflow, you’ll feel confident managing bone health in your primary care patients.

✉️ Want more practical pearls for managing chronic disease in clinic? Sign up for my NP mentorship program — real-world tools designed for new nurse practitioners in primary care.