For last week’s practice question, we quizzed participants on who needs to have a bone density evaluation according to the 2026 ADA Standards. 47% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below:
Answer Question Here
According to the 2026 ADA Standards of Care, what individuals should be recommended to have a bone density evaluation using dual-energy X-ray absorptiometry to evaluate for bone loss?
- A 67-year-old female living with frequent falls and no bone fractures. She is newly diagnosed with type 2 diabetes, taking only metformin, with a bone density test 1 year ago that was normal.
- A 49-year-old premenopausal woman with prediabetes who has a low vitamin D level but no history of bone fracture.
- A 59-year-old male living with type 2 diabetes, taking pioglitazone, and whose A1c is 8.7%.
- A 43-year-old man living with type 2 diabetes for five years, taking metformin and an SGLT2 inhibitor, without diabetes related complications, but did break his arm as a child.
Getting to the Best Answer
Answer A is incorrect: 20% chose this answer, “A 67-year-old female living with frequent falls and no bone fractures. She is newly diagnosed with type 2 diabetes, taking only metformin, with a bone density test 1 year ago that was normal.” This answer is tempting but incorrect. Per the 2026 ADA Standards of Care, she does meet criteria for assessing bone health due to her diagnosis of type 2 diabetes and risk factor of frequent falls, but she had a bone density test 1 year ago. Currently, the recommendation is to re-evaluate the bone density test in 2-3 years.
Answer B is incorrect: 26% chose this answer, “A 49-year-old premenopausal woman with prediabetes who has a low vitamin D level but no history of bone fracture.” This answer is incorrect. Per the 2026 ADA Standards of Care, it is recommended to assess bone health in postmenopausal women with other diabetes specific risk factors. This risk factor does not include low vitamin D levels.
Answer C is correct: 47% chose the correct answer, GREAT JOB. “A 59-year-old male living with type 2 diabetes, taking pioglitazone, and whose A1c is 8.7%.” Per the 2026 ADA Standards of Care, bone health needs to be assessed in men aged ≥50 years with type 2 diabetes and an A1c >8%. He is also on pioglitazone, a thiazolidinedione, which is another risk factor for low bone density.
Answer D is incorrect: 7% chose this answer, “A 43-year-old man living with type 2 diabetes for five years, taking metformin and an SGLT2 inhibitor, without diabetes related complications, but did break his arm as a child.” This answer is incorrect. Per the 2026 ADA Standards of Care, he has no diabetes-specific risk factors for bone loss. Diabetes duration is less than 10 years, he has no diabetes related complications such as peripheral or autonomic neuropathies, he is not on a high-risk medication for bone loss, and he has not had a bone fracture as an adult.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
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