The Role of DEXA Scanning in Secondary Fragility Fracture Prevention

Fragility fractures are often the first clinical sign of osteoporosis and represent a substantial source of morbidity, mortality, and healthcare expense in older persons. Despite clear evidence supporting secondary fracture prevention, postfracture care often emphasizes the recovery from the injury itself while insufficiently addressing the underlying skeletal disease. As a result, approximately 6% of patients will have a subsequent fragility fracture within 1 year of the initial injury. In addition, without intervention, osteoporosis will progress in these patients resulting in chronic pain, disability, and decreased quality of life. To slow the progression of osteoporosis, along with lowering the risk of secondary fragility fractures, the aim of this review was to assess the use of dual-energy X-ray absorptiometry (DEXA) in postfracture osteoporosis assessment and monitoring with a focus on its integration with pharmaceutical therapy, fall-prevention techniques, and fracture liaison services (FLS). Without the intervention of FLS, less than one-third of patients will initiate osteoporosis medication therapies within the first year of a hip fracture, despite strong guideline recommendations. DEXA-based bone mineral density evaluation enhances clinical risk stratification, promotes the initiation of evidence-based pharmacologic therapy, and improves osteoporosis detection. The use of DEXA within FLS models improved treatment adherence and subsequently reduced the number of secondary fractures. DEXA-guided postfracture care is essential for lowering recurrent fractures and enhancing outcomes for older persons, especially when incorporated into coordinated care pathways.