# A woman older than 65 has never been screened for osteoporosis and has no history of a fragility fracture. Which recommendation should the nurse provide?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=497908&lang=en  
> language: en  
> subject: Health Screening  
> category: HPM

## Question

A woman older than 65 has never been screened for osteoporosis and has no history of a fragility fracture. Which recommendation should the nurse provide?

## Option

1. Start calcium now and postpone testing unless a low-trauma fracture occurs
2. Schedule annual spine radiographs instead of a bone mineral density screening test
3. Use a fracture risk questionnaire without obtaining a bone density measurement
4. Arrange central dual-energy x-ray absorptiometry to screen for osteoporosis **✔ Correct answer**

**Correct answer: 4**

## Explanation

This client meets the age-based recommendation for osteoporosis screening. Central DXA measures bone mineral density and can identify osteoporosis before a fragility fracture, allowing evaluation and evidence-based fracture prevention.

## In-depth explanation

Quick answer
Arrange osteoporosis screening with central DXA. The client has crossed the universal screening age for women and has not previously been screened.

Why this is correct
Osteoporosis often causes no symptoms until a fracture occurs. Central DXA measures bone mineral density at clinically useful sites, allowing the care team to identify low bone mass and discuss fracture prevention before an injury reveals the disease.

Easy analogy or mental picture
Screening is like checking the strength of a bridge before a heavy load exposes a weak point. DXA estimates bone strength before a fracture, but the image does not replace clinical risk assessment or evaluation of secondary causes.

Memory hook
Age threshold reached plus no prior screening means measure bone density before the first fragility fracture.

NCLEX decision rule
For an asymptomatic woman above the routine screening threshold, choose central DXA rather than waiting for pain or fracture. Younger postmenopausal clients require risk assessment first, and secondary osteoporosis needs individualized evaluation.

Why the other choices are wrong
Calcium intake is part of bone health but does not replace indicated screening. Routine spine radiographs are not the preferred screening test, and a risk questionnaire alone does not substitute for DXA when universal age-based screening applies.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]USPSTF: Osteoporosis to Prevent Fractures ScreeningU.S. Preventive Services Task Force, 2025

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